FAMILY DATA SHEET - Suffield Academy

SUFFIELD ACADEMY
FAMILY DATA SHEET
Please fill in completely (print or type)
date
s a
STUDENT
Full Name
Preferred First Name
P Boarding P Day P Male P Female
Entering Grade
Place of Birth
Birth Date
Month Day Year
Home Address
Number
Street
Present School
City State Zip Code
Telephone
Area Code
Number
Student Cell
Area Code
Number
Admissions Office
185 North Main St.
Suffield, CT 06078
parents
Parent/Guardian 1
Parent/Guardian 2
Phone 860.386.4440
Fax 860.386.4411
saadmit@suffieldacademy.org
Home Address
Number
Street
Home Address
Number
Street
City State Zip Code
City State Zip Code
Telephone
Area Code
Number
Telephone
Area Code
Number
Occupation or Position
Occupation or Position
Firm Name
Firm Name
Business Address
Business Address
Number
Street
Number
Street
City State Zip Code
City State Zip Code
Telephone
Area Code
Number
Telephone
Area Code
Number
Cell Phone
Area Code
Number
Cell Phone
Area Code
Number
Fax (home or work?)
Area Code
Number
Fax (home or work?)
Area Code
Number
Email
Email
Secondary School Affiliation
Secondary School Affiliation
College
College
Student Lives With (check all that apply):
Check Any That Apply:
PFather PStepfather POther PFather is deceased PParents are divorced
PMother PStepmother
(please explain
on reverse side) PMother is deceased PParents are separated
BROTHERS AND SISTERS
Name School Age
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SUFFIELD ACADEMY
RELATIVES WHO HAVE ATTENDED SUFFIELD ACADEMY
Name relationship Class
s a
stepparents
stepmother
stepfather
Home Address
Home Address
Number
Street
Number
Street
City State Zip Code
City State Zip Code
Telephone
Area Code
Number
Telephone
Area Code
Number
Admissions Office
185 North Main St.
Suffield, CT 06078
Occupation or Position
Firm Name
Occupation or Position
Firm Name
Phone 860.386.4440
Fax 860.386.4411
saadmit@suffieldacademy.org
Business Address
Number
Street
Business Address
Number
Street
City State Zip Code
City State Zip Code
Telephone
Area Code
Number
Telephone
Area Code
Number
Cell Phone
Area Code
Number
Cell Phone
Area Code
Number
Fax (home or work?)
Area Code
Number
Fax (home or work?)
Area Code
Number
Email
Email
Secondary School Affiliation
Secondary School Affiliation
College
College
grandparents
grandparents for parent/guardian 1
grandmother
grandparents for parent/guardian 2
grandmother
grandfather
grandfather
Home Address
Home Address
Number Street Number Street
City State Zip Code City State Zip Code
Email
Email
additional comments here
www.suffieldacademy.org