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708 758 5190 (District)
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201 e. glenwood-dyer rd | glenwood, il 60425
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brookwood junior high school
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Parent/Legal Guardian
Information
Powerschool ID
Student First Name
Student Middle Initial
Student Last Name
Parent/Legal Guardian #1
First Name
Middle Initial
Last Name
Addr1
Addr2
City
State
Zip
Phone
Best Daytime Phone #
Email
Employer
Name of Employer
Work Phone #
Parent/Legal Guardian #2
First Name
Middle Initial
Last Name
Addr1
Addr2
City
State
Zip
Phone
Best Day Time Phone #
Email
Employer
Name of Employer
Work Phone #
Siblings Attending Brookwood School District 167
Student First Name
Student Middle Initial
Student Last Name
Birth Date
Grade
Please Select...
Pre-K
1st
2nd
3rd
4th
5th
6th
7th
8th
School
Please Select...
Longwood
Hickory Bend
Middle School
Junior High
Sibling #2
Student First Name
Student Middle Initial
Student Last Name
Birth Date
Grade
Please Select...
Pre-K
1st
2nd
3rd
4th
5th
6th
7th
8th
School
Please Select...
Longwood
Hickory Bend
Middle School
Junior High
Sibling #3
Student First Name
Student Middle Initial
Student Last Name
Birth Date
Grade
Please Select...
Pre-K
1st
2nd
3rd
4th
5th
6th
7th
8th
School
Please Select...
Longwood
Hickory Bend
Middle School
Junior High
Sibling #4
Student First Name
Student Middle Initial
Student Last Name
Birth Date
Grade
Please Select...
Pre-K
1st
2nd
3rd
4th
5th
6th
7th
8th
School
Please Select...
Longwood
Hickory Bend
Middle School
Junior High
Parental Status
Parent Status
Please Select...
Married
Separated
Single
Divorced
Joint Custody
Sole Custody (Must have signed court papers)
Widowed
Mother Deceased
Father Deceased
Child Resides With
Please Select...
Both Natural Parents
One Natural Parent
One Natural & One Stepparent Grandparents
Foster Parents
Mother Only
Father Only
Guardian
Sole Custody
Mother
Father
Visitation Restrictions
**Visitation Restrictions (check if applicable): OFFICE MUST HAVE A COPY OF THE ORDER. Visitation Restrictions; If one of the parents is restricted from visiting this child, please attach a copy of the court order to this emergency card. The court order copy will be placed in the student’s file. The schools can only honor court orders.
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