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COVMS SY ___________________

T-Tardy /-Absent X-Excused //-SSA

FullName_________________________________________________________________________Grade_______
Birthdate____________________________________ Teacher Nadia Murphy Room: D202
Parents Information:
Mothers name________________________________ Fathers name_________________________________
House number________________________________ House number_________________________________
Work number_________________________________ Work number_________________________________
Cell number__________________________________ Cell number___________________________________
Emergency contact person NAME:_______________________________________Contact #_______________
Relationship to child___________________________________________________________________________

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Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun

COVMS SY___________________
T-Tardy /-Absent X-Excused //-SSA

FullName_________________________________________________________________________Grade_______
Birthdate____________________________________ Teacher Nadia Murphy Room: D202
Parents Information:
Mothers name________________________________ Fathers name_________________________________
House number________________________________ House number_________________________________
Work number_________________________________ Work number_________________________________
Cell number__________________________________ Cell number___________________________________
Emergency contact person NAME:_______________________________________Contact #_______________
Relationship to child___________________________________________________________________________

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun

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