STUDENT INFORMATION SHEET

Assigned
inTACT Area
Date of
Exposure Trip
Student Facilitator
Homeroom
Adviser

PERSONAL INFORMATION
Full Name
InTACT Section
Contact Number/s

!
!
!
!
!
!
!
!
!
!
!
!

!
Current Address
!
EMERGENCY CONTACT INFORMATION
!
!
Name of Parent/
Guardian
!
Mobile Number/s
!
!
Landline Number/s
!
Current Address
!
!
!
!
!
!
!
!
!
!
!
!
!

Nickname
Course &
Block
Email
Address

Date: ________________________

!!
!!
!!
!!
!!
!!
!

I have understood the nature of the InTACT program and the importance of the exposure trip in my daughter/sons
social formation.

Name & Signature of

Parent/Guardian
Name of Student

Reminder:
Please return this form, fully accomplished, to the Student Facilitator on the designated deadline before the exposure trip.