JFAA
EPSOM SCHOOL DISTRICT
DECLARATION OF STUDENT RESIDENCE
It is our policy of the Epsom School District that the residency affidavit below be filled out by the Epsom resident seeking to initially register a student in the district. A new affidavit may also be required in situations subsequent to registration where a change of address of parent, student or some other party might call into question the student’s place of residence.
APPROVED: March 6, 1995 by Epsom School Board
AMENDED: January 6, 1998 by Epsom School Board
EPSOM SCHOOL DISTRICT
RESIDENCY AFFIDAVIT
DATE: SCHOOL:
1. Student Name 2. Age
3. Student Address
(Residential)
4. Mailing Address
(If different
from 3)
5. Owner/Renter of
Residence in 3
6. Relationship to
Student Parent (Check one. If "Other" please describe)
Guardian
Other
Describe
7. If name in item 5 is not the student’s parent or legal guardian please fill in the information below:
A. Parent/Guardian Name
B. Residential Address
C. Mailing Address
(If different)
D. Telephone #
I swear of affirm that the above information is true and accurate. In accordance with RSA 641:3, the Epsom School District may choose to initiate legal proceedings against any person who provides misleading or untrue information, or who omits information necessary to prevent statements herein from being misleading, in the completion of this Affidavit.
Signature of Person Named in Item 5