BOARDER’S INFORMATION SHEET

PLEASE WRITE IN CAPITAL LETTERS.

Date of Entry: _____________________________________________

Room Number: ____________________________________________

Full Given Name: __________________________________________

Nickname/s: ______________________________________________
Contact Number/s: _________________________________________

Working
Student

Facebook Link: ____________________________________________

Birthdate: ________________________________________________
Home Address: ____________________________________________
____________________________________________
____________________________________________

In Case of Emergency, please notify:

Full Given Name: __________________________________________
Relationship: ______________________________________________
Contact Number/s: _________________________________________
Complete Address: _________________________________________
_________________________________________
_________________________________________

___________________________________________________
True & Correct
(Signature over printed full name)

Your information will be kept confidential.