Information Regarding
Legal Custody

INFORMATION REGARDING LEGAL CUSTODY
(to be completed yearly)

Date ______________________

Child(ren)'s Name_____________________________________________ Grade(s) _________________

Address of child(ren)'s residence ________________________________________________________________
_________________________________________________________________

Child(ren) live with:
______ Both natural parents
______ Natural mother, step/adoptive father
______ Natural father, step/adoptive mother
______ Only Mother
______ Only Father
______ Grandparents (with legal custody)
______ Other relative (with legal custody)
                Relationship: ________________________________________
______ Other
                Please explain: _______________________________________

Residential parent/guardian:

Name: ______________________________________________________
Address: ____________________________________________________
City, State, Zip _______________________________________________
Phone:______________________________________________________

Is there a court order (or pending order) affecting the custody and/or residency of the child(ren)?

Please attach a copy of the page of the court decision showing the custody ruling. We MUST have a copy in our files.

****IT IS THE PARENTS RESPONSIBILITY TO INFORM THE SCHOOL OF ANY SUBSEQUENT****
MODIFICATIONS DURING THE CHILD'S TENURE AT THE SCHOOL

Non-residential parent:
Name ____________________________________________________
Address __________________________________________________
City, State, Zip ____________________________________________
Phone ___________________________________________________

Does non-residential parent have visitation rights?

-Is there a court decision that states that the non-residential parent should NOT receive school information or attend school activities?

-Is the non-residential parent responsible for paying tuition?

Signature ____________________________________________ Date _____________________

  *IF INFORMATION ON EACH CHILD IS DIFFERENT, PLEASE COMPLETE A FORM FOR EACH

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