www.genderspecLrum.org 310-788-4412 lnfo[genderspecLrum.

org




!"#$"% '#()*+,-" ."/,+0%10,2# 32%4+ 5/*1%$,1#6

_______________ School ls commlLLed Lo recognlzlng Lhe rlch dlverslLy of our sLudenLs. lf you have any
quesLlons abouL any of Lhe lnformaLlon we are collecLlng, please don'L heslLaLe Lo dlscuss wlLh us.

-----------------------------------------------

Chlld's referred llrsL name:
Chlld's Legal llrsL name: ____uecllne Lo sLaLe

Chlld's Cender: ____uecllne Lo sLaLe _____lemale _____Male _____CLher (please share chlld's gender,
below)
_____________________________________________

Chlld's preferred gender pronoun: ___Pe ___She ___1hey ___CLher (lf oLher, please share wlLh us
how your chlld prefers Lo be addressed)

_____________________________________________

Chlld's sex on blrLh cerLlflcaLe: _____lemale _____Male ______lnLersex /CLher ____uecllne Lo sLaLe
(see below lf you wlsh Lo share deLalls)

ls Lhere anyLhlng abouL your chlld's gender or sex LhaL you would llke for us Lo know? lf you prefer Lo
share Lhls lnformaLlon prlvaLely, aLLach a separaLe noLe or we can seL up a Llme Lo dlscuss wlLh you ln
person. lease know LhaL ______________ school conslders Lhls prlvaLe and confldenLlal lnformaLlon
LhaL wlll only be shared wlLh your expressed permlsslon and guldance.














www.genderspecLrum.org 310-788-4412 lnfo[genderspecLrum.org




!"#$"% '#()*+,-" ."/,+0%10,2# 32%4+ 5+0*$"#06

_______________ School ls commlLLed Lo recognlzlng Lhe rlch dlverslLy of our sLudenLs. lf you have any
quesLlons abouL any of Lhe lnformaLlon we are collecLlng, please don'L heslLaLe Lo dlscuss wlLh us.

-----------------------------------------------

referred llrsL name:
Legal llrsL name: ____uecllne Lo sLaLe

Cender: ____uecllne Lo sLaLe _____lemale _____Male _____CLher (please share your preferred gender,
below)

_____________________________________________

referred gender pronoun: ___Pe ___She ___1hey ___CLher (lf oLher, please share wlLh us how you
prefer Lo be addressed)
_____________________________________________

Sex llsLed on blrLh cerLlflcaLe: _____lemale _____Male ______lnLersex /CLher (see below lf you wlsh Lo
share deLalls)

ls Lhere anyLhlng abouL your gender or sex LhaL you would llke for us Lo know? lf you prefer Lo share Lhls
lnformaLlon prlvaLely, aLLach a separaLe noLe or we can seL up a Llme Lo dlscuss wlLh you ln person.
lease know LhaL ______________ school conslders Lhls prlvaLe and confldenLlal lnformaLlon LhaL wlll
only be shared wlLh your expressed permlsslon and guldance.