STUDENT INFORMATION SHEET 2014/2015

Name: ___________________________ Phone Number: ______________________

Address: ____________________________________________________________
Birthday: _____________________
Mother/Guardians Name: ______________________________________________
Best Phone Number to be reached at: _____________________________________
Email: _____________________________________________________________

Father/Guardians Name: ________________________________________________

Best Phone Number to be reached at: ________________________________________
Email: ________________________________________________________________

Emergency Contact: ____________________________________________________

Relationship: _____________________

Phone Number: __________________________

Medical Concerns or Special Needs:

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Activities Involved in:
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Anything else you would like me to know:
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