Army Family Team Building

Level III

Family Readiness Group Leadership

Sample Newcomer’s Information Sheet
In case of an emergency, the unit needs to know who you would like for us to contact. Please provide the following information so we can help you if you are unable to help yourself.
1. Full Name and Rank of Soldier:

Unit 2. Are you married? Yes No

Platoon (circle)

Squad

(if no, answer #3 with family member you wish to receive newsletters and information from the unit)

3. Name of spouse or family member: Mailing Address: City, State, Zip: Home Phone: Email Address: 4. Do you have children? Yes No (circle) No Due Date: Age: Work Phone: Cell Phone:

Is your spouse pregnant at this time? Yes Child’s Name: School/Day Care: Child’s Name: School/Day Care: Child’s Name: School/Day Care: Child’s Name: School/Day Care: Child’s Name: School/Day Care:

Age:

Age:

Age:

Age:

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Army Family Team Building

Level III

5. Does your spouse and or child/children plan to leave the area during a deployment? Yes No (Circle)

If yes, please provide contact information Address: City, State, Zip Phone Number: Does your spouse have a driver’s license? Does your spouse have access to a car? Yes Yes No No

What is your spouse’s first language? _____________________________________ Is an interpreter necessary? Yes No Are there any family pets in the home? Yes No

If you or your spouse were to get sick or need assistance, who in the local area would you like for us to notify? This person should be close to the family and be able to help with the children. This person should be on all paperwork with schools and daycare centers as an emergency contact. This way if your spouse cannot pick up the children, there is a back-up plan already in place and we can notify that person for assistance. Name: Home Phone: Email Address: Do any of your family members have special needs? Explain: YES NO (circle) Work Phone: Cell Phone:

Note: Include the Privacy Act statement on your Information Sheet. As a Soldier fills out this sheet for his/her family, inform him/her that this information will be made available to the FRG for official purposes only.
2006/7
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Army Family Team Building

Level III

Privacy Act Statement
Here is an example of the Privacy Act Statement
AUTHORITY: Title 10, United States Code, Section 3013. PRINCIPAL PURPOSE(S): The personal information requested will be used to compile a Family Readiness Group (FRG) Membership Roster and/or Phone Tree. ROUTINE USE(S): Any information you provide may be disclosed to key leaders within the unit FRG or in accordance with the DoD “Blanket Routine Uses” set forth at the beginning of the Army’s compilation of system of records notices. DISCLOSURE: Disclosure is voluntary.

My personal information may be included on a FRG Membership Roster and/or Phone Tree. I understand that I may withdraw this consent at any time.

Printed Name/Signature

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