Parent/Guardian Last Name
Relationship to Child (i.e. Father, Step-mother etc.)
Spouse or Second Adult Last Name
Relationship to Child (i.e. Father, Step-mother, etc.)
Physical Home Address
P. O. Box Number
Home Telephone Number
Cell Phone Number
Township, City or Village of
1. List any child between the ages of new born to 20 years of age residing at the address listed above.
2. If any child has a diagnosed disability, and needs special education services from the school district, mark the Special Needs box.
School attending Fall of 2010
Grade Attending, Fall 2010
Special Needs: If your child has a diagnosed disability, and needs special education services from the school district, choose the "Yes" button.
Seymour Community School District
10 Circle Drive
Seymour, WI 54165
Phone: (920) 833-2304
Fax: (920) 833-6037
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