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Family Information Form

This information will be used to include families in CMC's emergency notification system, update our records, and send families CMC correspondence and event notices either by mail or email. CMC does not share personal information.

I. Student Information
Full Name:
 Nickname:
  

Student maintains residence with:
both parents  mother  father  independent  other 

Check if appropriate:
parents divorced  parents separated  father deceased  mother deceased

Please list all CMC relatives (including immediate family)
(Example: John Smith, Brother, 2008) Please list each on a separate line


II. Parent Information ~ Father
Full Name
 Nickname
 Prefix
Home Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Home Phone:
 Cell Phone:
 Preferred Email:
Business Information
Name of Company:
 Industry:
 Position/Title:
Business Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Business Phone:
 Business Fax:
Business Email:
 Business Web Address:
Corporate/Foundation Board Memberships: Please list each on a separate line


III. Parent Information ~ Mother
Full Name
 Nickname
 Prefix
Home Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Home Phone:
 Cell Phone:
 Preferred Email:
Business Information
Name of Company:
 Industry:
 Position/Title:
Business Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Business Phone:
 Business Fax:
Business Email:
 Business Web Address:
Corporate/Foundation Board Memberships: Please list each on a separate line


IV. Parent Information ~ Stepfather
Full Name
 Nickname
 Prefix
Home Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Home Phone:
 Cell Phone:
 Preferred Email:
Business Information
Name of Company:
 Industry:
 Position/Title:
Business Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Business Phone:
 Business Fax:
Business Email:
 Business Web Address:
Corporate/Foundation Board Memberships: Please list each on a separate line


V. Parent Information ~ Stepmother
Full Name
 Nickname
 Prefix
Home Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Home Phone:
 Cell Phone:
 Preferred Email:
Business Information
Name of Company:
 Industry:
 Position/Title:
Business Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Business Phone:
 Business Fax:
Business Email:
 Business Web Address:
Corporate/Foundation Board Memberships: Please list each on a separate line


VI. Paternal Grandparent Information
 please send correspondence  please do not send correspondence
Last Name
 First Name
 Salutation (i.e. Mr. & Mrs.)
Last Name
 First Name
 Salutation (i.e. Mr. & Mrs.)
Home Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Home Phone:
 Email:


VII. Maternal Grandparent Information
 please send correspondence  please do not send correspondence
Last Name
 First Name
 Salutation (i.e. Mr. & Mrs.)
Last Name
 First Name
 Salutation (i.e. Mr. & Mrs.)
Home Address:
 City:
State/Province:
 Zip/Postal Code:
 Country:
Home Phone:
 Email:


Validation:
   

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