You are on page 1of 1

Important Student Information

Student Name:_______________________________________
Nickname (if applicable): ______________________________
Parents/Guardian: ___________________________________
Home number: ________________ ____________________
Work number: ________________ ____________________
Cell number: _________________

____________________

E-mail: ____________________ _______________________


In case of an emergency: _____________________________
___________________________________________________
Your child will ride home via: car bus(____) daycare(___)
Does your child have any allergies? Yes

No

______________________________________
______________________________________
Is there any special information about your
child you would like to share? ____________
_____________________________________
_____________________________________
______________________________________