Parent/Guardian Information Form

Please submit the completed form by Monday, January 6, 2014.
An asterisk (*) indicates a required field.
Note: Please allow 72 hours for this action item to be checked off on your student's checklist.

Student Information

Gender *

If the student does not have a cell phone, please type in 0.
 Yes  No

Parent/Guardian Contact Information

Parent/Guardian 1Parent/Guardian 2
Relationship to Student *

Business Information

Parent/Guardian 1Parent/Guardian 2

Volunteer Activities

Parent/Guardian 1Parent/Guardian 2
Are you interested in getting involved in any of the following activities?

Parent/Guardian Board Affiliations

Parent/Guardian 1Parent/Guardian 2

Other Information

Parent/Guardian 1Parent/Guardian 2

Parent's Marital Status

Is Parent 1 Living? *
Is Parent 2 Living? *

Family Seasonal Address (if any)

Other Children

 First NameLast NameGenderBirthdate
Name of SchoolYear in school
Child 1
Child 2
Child 3
Child 4
Child 5

Relatives (Who Are Attending or Who Have Attended Fairfield University)

 NameMaiden NameRelationship to StudentYear
Relative 1
Relative 2
Relative 3
Relative 4
Relative 5

More Information

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Note: Please do not submit this form more than once.
Allow 72 hours for this action item to be checked off on your student's checklist.

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