Post by xBlink on Mar 27, 2010 13:34:05 GMT -5
STUDENT INFORMATION
Full Legal Name
(Last/Family/Sur Name, First/Given Name, FULL Middle Name)
Kisu, Kaminari No
Preferred Name
(If NOT First/Given Name) [/size]
Kain
Former Last Names
(If Applicable, Otherwise State ‘Not Applicable’) [/size]
N/A
Date of Birth and Time
(mm/dd/yy, hh:mm AM/PM) [/size]
01/01/95
Gender
(Male/Female) [/size]
Male
Race
(Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___Africa
_X_Asian
___Latin American
___Caucasian
___Pacific Islander
___Other (Specify) ______________
Ethnic Background
(Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___ Africa
_X_Asian
___Latin American
_X_American
___Pacific Islander
___Other (Specify) ______________
US Social Security Number
(If US Citizen, Otherwise State ‘Not Applicable’) [/size]
[Warning: Please DO NOT use yours, or anybody you knows actually number]
97865-54-098
Address
(Number and Street, City; State, Zip Code [If Not Applicable, Please indicate Otherwise]) [/size]
Varies
E-Mail Address
( If Applicable, Otherwise State ‘Not Applicable’; something@somewhere.com) [/size]
N/A
IM Address
( If Applicable, Otherwise State ‘Not Applicable’; list all current; username, site) [/size]
N/A
Desired Email and IM Username
(Username, Password) [/size]
cloudy, 1198
Home Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
N/A
Cell Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxxx) [/size]
(432) 333-0231
HOUSEHOLD INFORMATION
Who Has Legal Custody?
( Place An ‘X’ Beside Any That Apply)
___Both Parents
___Father
___Mother
_X_Grandparent(s)
___Guardian(s)
___Ward of Court
Student Lives With
(Place An ‘X’ Beside Any That Apply) [/size]
___Both Parents
___Father
___Mother
___Step Parent
___Grandparent(s)
___Guardian(s)
___Agency/Social Services
___Foster Parent(s)
_X_Alone
___Student’s Spouse/Partner
___Other Relative(s)
Parent/Guardian’s Legal Name
(Last/Family/Sur Name, First/Given Name) [/size]
Rin Kisa – Dad; Kaeda Timoko
Name Of Parent(s)/Sibling(s) Whom Attend/Have Attended Rosethorn Institute
(Name, Relationship, Current Grade/Year Attended; [Indicate Graduation Date With An Asterisk (*)]
________________________________________ ________________________________________ ________________________________________ ________________________________________
GUARDIAN INFORMATION
Name of Parents/Guardian NOT living in the primary household and current Address.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
PREVIOUS SCHOOL(S) INFORMATION
Last School Attended
[/size] (Name) [/color] [/size]
TeaYoung High.
Grade
9th
Has your child ever been retained?
(Yes or No If yes, what grade?) [/size]
No.
Has student attended pre-school?
(Yes or No If yes, check one of the following:) [/size]
___ PK-Public School
___Private Non-Profit PK
___Public Sponsored PK (Title 1)
_X_Private For Profit PK
___Head Start
___Other Public School
___PK Private School
List other schools student has attended:
_Pinecrest Academy______________________________________________________
_Newyork Central Elementary______________________________________________ ___________________________________________________________________________
Has your child ever received any of the following services? [/size]
(If yes, check all that apply) [/size]
___Special Education*
___Gifted
___Speech*
___ESOL
___EIP Reading/Math
___Remedial
___OT/PT*
___504
HOME LANGUAGE SURVEY
Parent or Guardian must complete. [/color]
First Language learned by student?
Japanese
Language student uses at home?
English
Language student uses most often?
English
Country of Origin?
Japan
Date entered US schools:
08/01/00
[/size]LEGAL AGREEMENT
[X] By Checking This Box I Hereby Express My Understanding That Rosethorn Institute For The Genetically Advanced Accepts Full Responsibility For any harm done to students. I hereby surrender this child over to the evil clutches of The Headmaster unknowingly and lots other strange fine print I didn’t even read because I assumed this was just another stupid thing. I did not actually read the small part about my student not being allowed to leave the campus unless permission is granted by The Headmaster himself (even though he would never agree to it) even though I said I read it and agree to it.