Student and Family Information Sheet

Dear Parents/Guardians:
Please take the time to fill out this form and have your child return it to me by Friday, August 22nd.
Thank you!

Last Name _____________________________

First Name ______________________________

Preferred Name/Nickname __________________________

Date of Birth_______________________

Address ___________________________________________________________________________________

Parent/Guardian _________________________________
Home Phone _____________________________
Work Phone ____________________________

*Please indicate your preferred contact number

Cell Phone ____________________________

Best time to be reached ____________________________

Parent/Guardian _________________________________
Home Phone _____________________________
Work Phone ____________________________

*Please indicate your preferred contact number

Relationship ______________________

Relationship ______________________
Cell Phone ____________________________

Best time to be reached ____________________________

Please check one:

____ Yes! We have internet access at home.
____ No! We do not have internet access at home.
Additional e-mail addresses you would like included (optional):
_____________________________________________________________________________________
_____________________________________________________________________________________

Allergies? _______________________________________________________________________

Parent Signature__________________________________________ Date___________________