For the 2023-24 School Year: This form must be completed for all new students attending The Summit School and their parents/guardians. Asterisk (*) indicates a required form field. An email-based reference copy of the form information will be sent to the person submitting the form once processed.
STUDENT INFORMATION
Student 1 Name *
First Name
Last Name
Student 1 Date of Birth *
MM
DD
YYYY
Student 1: Which building will this student be attending in September 2023
Select OptionUpper SchoolLower School
Student 1 Primarily Resides With | Select One or More Options
Select one or more options that best describes who your child primarily resides with for the individuals that you include on this form below.
P1 = I am the primary contact for my child/childrenP2 = I am the spouse of Parent/Guardian 1P3 = I do not reside at my child's primary address
Student 1 Custody Alert: Name of Person and Relationship to Your Child
Is there a person who should not have access to your child?
Student 1 Custody Alert: Is there an order of protection?
Select OptionYesNo
Student 2 Name
Student 2 Date of Birth
Student 2: Which building will this student be attending in September 2023
Student 2 Primarily Resides With | Select One or More Options
Student 2 Custody Alert: Name of Person and Relationship to Your Child
Student 2 Custody Alert: Is there an order of protection?
Home Address for Student 1 and Student 2 *
Address 1
Address 2
City
Select OptionALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
State/Province
Zip/Postal Code
Country
Home Phone *
(###)
###
####
PARENT/GUARDIAN 1 INFORMATION (I am the primary contact for my child/children)
Relationship
Select OptionMotherFatherStepmotherStepfatherGrandmotherGrandfatherGuardian
Preferred Title
Select OptionMrs.Mr.Ms.MissDr.ProfessorRabbiJudge
Name
Cell Phone (Personal)
Cell Phone Carrier *
For text-to-cell messages: Please note that depending on your cell phone plan, you may get charged for text messages if you do not have a SMS plan.
Select OptionAIO WirelessAlltelAT&TBell MobilityBluegrass CellularBoostCellcomCellular OneCellular SouthCellular One of East TexasCentennialCingularConsumer CellularCricketCspireFIDOGCIGoogle FIHelioInland CellularMetro PCSNemontNextechNextelNonePioneer WirelessRepublic WirelessSouthern LINCSprint PCSSunComT-MobileUS CellularUSA MobilityVerizonVirgin MobileVoice StreamWest Central Wireless
Email (Personal)
Are you receiving Summit eBlast our school newsletter via email?
Summit eBlast is published and emailed monthly. Special editions are issued by the school and Summit's Parents' Association as information is available.
Select OptionYesNoNew to Summit
Work Profile/Select Industry
Please complete the work information requested below. Thank you.
Select OptionArts & EntertainmentComputer/IT/Data/TechnologyConsumer Goods: Food/PharmaceuticalsEducation/TrainingFinancial Services/InsuranceGovernment: City/State/FederalHealthcare/Social ServicesHospitality/Recreation/Food & BeverageLaw/Public SafetyManufacturing/Construction/TradesMedia: Advertising/Communications/PublishingNonprofit OrganizationPersonal Consumer Services: Beauty/Fashion/JewelryReal EstateRetailScience/Research/Engineering/ArchitectureUtilities/Environmental/EnergyTransportation
Employer
Occupation/Title
Work Address
Work Phone
Work Email
PARENT/GUARDIAN 2 INFORMATION (I am the primary contact for my child/children)
PARENT/GUARDIAN 3 INFORMATION (I am the primary contact for my child/children)
Name of Person Completing This Form *
