If your student has any medical issues or court orders, please contact Sharon Schmidt directly at the school.

301-725-3228 x2210   SSchmidt@pallottihs.org

Please fill out the entire form.

Required
Required

Additional Student Names

Please list any aditional student(s) you currently have enrolled in Pallotti.

If all of the contact information is the same for your current student(s), you only need to fill the form out once.

Primary Parent/Guardian ___________________

Required
Required
Required
Address
Required

Secondary Parent/Guardian ___________________

Address

Parent/Guardian Emergency Contacts

Please list the names of persons to whom we can contact in an emergency if we are unable to contact the parent(s)/guardian(s) provided above.  Students will not be releases to anyone that is not designated below.