Student Change of Data Form
 

     It is very important that the schools have up-to-date contact information in the event we must contact a parent or guardian. Please complete and sign the Change of Data Form and return to your child's teacher.

Please click here for a printable copy of the form (.pdf)

COMMACK UFSD
STUDENT DATA CHANGE FORM
Please Print

School_____________________                                Date_______________________

Name of Student       _______________________________________                           Grade____________ 

PLEASE PRINT ONLY CORRECTIONS/CHANGES TO BE MADE ON STUDENT’S RECORD BELOW 

Date of Birth                                                                                                                                                         

Home Telephone #                                                                                                                                              

Parent/Guardian Names                                                                                                                                     

Father’s Cell Phone #                                                            Father’s Work Phone #                                     

Mother’s Cell Phone #                                                           Mother’s Work Phone #                                      

Emergency Contact Name                                                                                                                                 

Relationship to Student                                                                                                                                       

Home Phone #                                                                Cell Phone #                                                               

Emergency Contact Name                                                                                                                                  

Relationship to Student                                                                                                                                       

Home Phone #                                                                Cell Phone #                                                               

Physician’s Name                                                            Physician’s Phone #                                                  

Dentist’s Name                                                                Dentist’s Phone #                                                      

Any other information to be changed or corrected                                                                                            

Person Requesting Change                                                                                                                                 

Signature of Person Requesting Change (form must be signed)                                                                          

Print Name of Person Requesting Change _____________________________________________________

pc:  Building Nurse, School Office, Hubbs Attendance