Parent Contact Information

 

___________________________________              ____________________________________

Student’s Last Name                                                Student’s First Name

 

__________________________________________________

Mother’s Name

 

__________________________________________________

Mother’s Address

 

_______________________________          ____________________________________           

Mother’s HOME Phone Number    Mother’s WORK/CELL Phone Number

 

 

_____________________________________________________
Email Address

 

 

 

_____________________________________________________

Father’s Name

 

_____________________________________________________

Father’s Address (If Different)

 

 

_______________________________          ____________________________________           

Father’s HOME Phone Number                 Father’s WORK/CELL Phone Number

 

 

______________________________________________________

Email Address

 

Allergies?___________________________________________________________________

 

_________YES, allowed to watch “G,” “PG,” and “PG—13” movies

 

_________NO NOT ALLOWED!

 

 

_________YES, can be in class pictures—NOT for publication—Just classroom fun.

 

_________NO, CANNOT BE IN ANY PICTURES