Student Information

Student name: ______________________________ Age:

__________
Birthday:__________________ Any Allergies?__________________
Parent name: ________________________ Phone:
_______________
Parent name: ________________________ Phone:
_______________
Please list a few days and times that would work best for
you, should I need to call and schedule a conference:
___________________________________________________________
_
Emergency Contact Name:
__________________________________
Relationship to Student: _______________ Phone #:
____________
Brothers & sisters at Hilldale:
_______________________________

Transportation from school (circle please):

First Day:
Car Rider
Bus Rider #______

North Walker

South Walker

Daycare ________________

Remainder of the year:

Car Rider

North Walker

Bus Rider #______

South Walker

Daycare ________________