St. Stephens School of Grand Island
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Student Information
Student Name:
*
Grade Level:
*
Male/Female:
*
Male
Female
Birth Date:
*
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
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28
29
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31
Year
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
New Student:
*
Yes
No
Family Information
Family Name:
*
Address
Street Address:
*
City:
*
Zip Code:
*
Home Phone:
Family Email:
Primary Contact
Name:
*
Relationship to Student:
Mother
Father
Guardian
Other
Contact Information
Phone - Home:
Phone - Work:
Phone - Cell:
Email:
Secondary Contact
Name:
*
Relationship to Student:
Mother
Father
Guardian
Other
Contact Information
Phone - Home:
Phone - Work:
Phone - Cell:
Email:
