EmailMeForm
ICS-West Student Data Sheet
Please read and check all information carefully for accuracy before submitting. Your responses will be used to create your child's profile in our student database. Any contact listed on this form will have permission to pick up your child from school. You must list at least 2 contacts and may list up to 5.
Student's Legal Name
*
First
Middle
Last
Please type full name exactly as it appears on child's birth certificate.
If student should be called something other than first name in school (such as a middle name or formal nickname), please list here.
Student Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Please select
Male
Female
This information is required for the School District
of Philadelphia's database.
Ethnicity
*
Please select
American Indian/Alaskan)
Black (not Hispanic)
Hispanic
White (not Hispanic)
Multi-racial
Asian/Pacific Islander
Native Hawaiian/Other Pacific Islander
This information is required for the School District
of Philadelphia's database.
Are there any court-ordered custody arrangements for your child? If yes, please submit a copy of the custody agreement during registration.
*
Please select
No
Yes
Student Address
House Number
*
Student Address
Street Name
*
Apartment/Unit Number
Zip Code
*
Contact #1
*
First
Last
Must be a primary parent/legal guardian and live with student at the student's primary address.
Contact #1 - Relationship to Student
*
Please select
Mother
Father
Guardian
Grandma
Grandpa
Aunt
Uncle
Babysitter
Friend
Brother
Sister
Other
Contact #1 - Email
*
Contact #1 - Primary Phone Number
*
###
-
###
-
####
This phone number will be eligible to receive school text messages and will receive periodic automated calls from the school with news and information, including emergency phone calls.
Contact #1 - Alternative Phone Number
###
-
###
-
####
This phone number will be eligible to receive school text messages and will receive automated calls from the school in emergencies only.
Contact #1 - Work Phone Number (if applicable)
###
-
###
-
####
Ext.
###
Contact #1 - Place of Employment (if applicable)
Contact #2
*
First
Last
This contact should be student's 2nd parent/guardian if applicable. Otherwise, this can be student's first emergency contact.
Contact #2 - Relationship to Student
*
Please select
Mother
Father
Guardian
Grandma
Grandpa
Aunt
Uncle
Babysitter
Friend
Brother
Sister
Other
Contact #2 - House Number
Leave blank if same as student.
Contact #2 - Street Name
Leave blank if same as student.
Apartment/Unit Number
Leave blank if same as student.
Contact #2 - Zip Code
Leave blank if same as student.
Contact #2 - City
Leave blank if same as student.
Contact #2 - State
Leave blank if same as student.
Contact #2 - Email
Contact #2 - Primary Phone Number
*
###
-
###
-
####
This phone number will be eligible to receive school text messages and will receive automated calls from the school in emergencies only.
Contact #2 - Alternative Phone Number
###
-
###
-
####
Contact #2 - Work Phone Number (if applicable)
###
-
###
-
####
Ext.
###
Contact #2 - Place of Employment (if applicable)
Contact #3
First
Last
Contact #3 - Relationship to Student
Please select
Mother
Father
Guardian
Grandma
Grandpa
Aunt
Uncle
Babysitter
Friend
Brother
Sister
Other
Contact #3 - Phone
###
-
###
-
####
Contact #4
First
Last
Contact #4 - Relationship to Student
Please select
Mother
Father
Guardian
Grandma
Grandpa
Aunt
Uncle
Babysitter
Friend
Brother
Sister
Other
Contact #4 - Phone
###
-
###
-
####
Contact #5
First
Last
Contact #5 - Relationship to Student
Please select
Mother
Father
Guardian
Grandma
Grandpa
Aunt
Uncle
Babysitter
Friend
Brother
Sister
Other
Contact #5 - Phone
###
-
###
-
####
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