<<<<< Mrs. McCormicks Student Info.

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Student Name: ___________________
Date of Birth: _______
My child prefers to be called: _________________________
Address: ________________________
City/ Zip ________
Afternoon Transportation (circle one) bus # ____ / walker / parent pickup
Sibling: ____________ Grade: _____ Teacher: _________
Sibling: ____________ Grade: _____ Teacher: _________
Sibling: ____________ Grade: _____ Teacher: _________

Parent/ /Guardian: _______________

Parent/ /Guardian: _______________

Home Phone: ( ) _____________

Home Phone: ( ) _____________

Cell Phone: ( ) ______________

Cell Phone: ( ) ______________

Work Phone: ( ) _____________

Work Phone: ( ) _____________

e-mail: _____________________

e-mail: _____________________

Perferred Method e-mail / phone / text

of Contact

Perferred Method e-mail / phone / text

of Contact

Do you mind if your childs picture is posted on Twitter and/or my website? (I usually take
pictures of the students learning in groups.) yes or no
Does your child have any allergies? yes or no _______________
____________________________________________