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Student Information Sheet

Student Name______________________________________________________
Age_________________

DOB___________

Grade __________

Address___________________________________
_____________

Phone #

Parent/ Guardian Name:

Parent/ Guardian Name:

Cell:

Cell:

Work Place:

Work Place:

Work Phone:

Work Phone:

Best time to contact:

Best time to contact:

Student Lives with____________________________________


Emergency Contact:
Name______________________________

Phone Number_____________

Name______________________________

Phone Number_____________

Allergies/ Medical concerns: ___________________________________________


Does your child wear glass? ____________

When? ___________________

How would you like to receive reminders?


______email

________ Text

________ Both

Parent Email address: ________________________________________________


Texting Phone Number: ______________________________________________

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