The Good Shepherd Catholic Montessori Student Record

Student Information. Please enter your child's name, not your name.

Parent Email*
Confirm Parent Email*

Please update the following information for your child.

Date of Birth*
Public School Child Would Attend, example Maddux Elementary*
Emergency Contact - #1 In case parent(s) cannot be reached*
Emergency Contact - #1 Phone*
Emergency Contact - #2 *
Emergency Contact - #2 Phone*
Besides parents, who is authorized to pick up student?*
Contact Information for Each Authorized Pick-Up*
Medical Insurance Company*
Medical Group Number*
Medical Policy ID*
Medical Subscriber Name*
Physician Name*
Physician Address*
Physician Phone*
Permission to Transport to Hospital*
  • Yes
  • No
Preferred Hospital
Dentist Name*
Dentist Address*
Dentist Phone*
Allergies - List or enter None*
Dietary Restrictions - List or enter None*
Do you want to be included in PTO Directory?*
  • Yes
  • No
Permission to Photograph*
  • Yes
  • No
Father's Name*
Father's Phone and Email*
Mother's Name*
Mother's Phone and Email*

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