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K12. wi. us FAX 608 743-7491 www. janesville. k12. wi. us/RUHS STUDENT LEGAL NAME as it appears on birth record or other legal document LAST NAME FIRST NAME MIDDLE Full SUFFIX Jr. II III NICKNAME AGE GRADE ENTERING FALL 2014 2015 HOME ADDRESS NUMBER STREET NAME APT. CITY STATE ZIP GENDER MALE BIRTH DATE FEMALE RESIDENT SCHOOL PARENT / GUARDIAN INFORMATION WORK PHONE CELL PHONE EMAIL HOME PHONE PARENT SIGNATURE DATE The right of the student to be admitted to school and to participate fully...
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