Personal Information Update

Please help us keep our records up-to-date by submitting any changes to your personal information. Please fill out all required fields and any additional fields that need to be changed.

___________________________

***REQUIRED FIELDS***

	Date Changes Effective*

Father's Name (enter N/A if not applicable)

	First Name*

	Last Name*

	Middle Initial

Mother's Name (enter N/A if not applicable)

	First Name*

	Last Name*

	Middle Initial

___________________________

***ADDITIONAL FIELDS***

Primary Contact Information

	Home Phone

	Primary Email Address

	Home Address Line 1

	Address Line 2

	City

	State

	Zip Code

Alternate Phone Numbers and Email Addresses

Note: If you update a phone number, please re-enter two (2) numbers other than your home phone in the two Saf-T-Net fields in the next section. These numbers are for use with the Saf-T-Net emergency notification service.

	Father - Work Phone

	Father - Cell Phone

	Father - Email Address

	Mother - Work Phone

	Mother - Cell Phone

	Mother - Email Address

Saf-T-Net Information

If you have updated a phone number above, please enter two (2) numbers other than your home phone in the two Saf-T-Net fields below. The two numbers you designate will be entered for use with the Saf-T-Net emergency notification service.

	Saf-T-Net Phone 1

	Saf-T-Net Phone 2

Employer Information

	Employer - Father

	Employer - Mother

Additional Information

Please Note: Questions marked with an asterisk (*) are required.

This Week at Trinity

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