Student Information

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STUDENT INFORMATION

Name: _______________________ Date of Birth: __________ Age: ______

Child’s Home Address: ________________________ Phone #: ____________

Parent/Guardian Name: ____________________ Contact #: ______________

Email: ______________________________ Can I text you?: Yes No

Parent/Guardian Name: ____________________ Contact #: ______________

Email: ______________________________ Can I text you?: Yes No

Allergies or Health Concerns: _____________________________________

Siblings (name and age): ________________________________________

Can your child have his/her picture taken and displayed? Yes No

What would you like me to know about your child? ________________________

________________________________________________________
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What is the primary way your child will go home each day? Please let me know if at
any time this changes. _________________________________________

EMERGENCY CONTACT INFORMATION


Name: ______________________________ Contact #: ______________

Relationship to Child: _______________________

I AM LOOKING FORWARD TO GETTING TO KNOW YOUR CHILD!

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