FAMILY RECORD

PLEASE PRINT

(One per family.)

Family Name: ___________________________________ Phone: __________________

Address: _____________________________________________ Zip: ______________

Emergency Contact Name: _________________________________________________

Phone: __________________ Relationship: ____________________________________

Children in Our Lady of Consolation School:

Child’s Full Name                                                         Grade                           Date of Birth

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Father's Full Name: ________________________________________________________

Place of Employment: ______________________________________________________

Work #: _____________________________ Cell Phone #: ________________________

E-Mail Address: __________________________________________________________

Mother's Full Name: ______________________________________________________

Place of Employment: _____________________________________________________

Work #: _____________________________ Cell Phone #: ________________________

E-Mail Address: __________________________________________________________

Transportation to and from school:

Please circle one.

Bus                  Torresdale Line                        Tulip Line                     Car Line