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Parent Contact Information Form (Kimberly Martin) 8/20/2014
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Parent Contact Information

PLEASE FILL OUT AND RETURN TO MRS. MARTIN

 

 

Student Name__________________________________   DOB_______________

 

Address ____________________________________________________

City___________________________   State______   Zip Code________

 

Mother____________________________________________________________    

Address

(if different from child’s)___________________________________________    

City___________________________ State______   Zip Code_________

Home (     )___________________________

Work (       )___________________________

Cell (       )____________________________

E-mail address_______________________________________________

 

Father_____________________________________________________________    

Address

(if different from child’s)___________________________________________    

City___________________________ State______   Zip Code_________

Home (       )__________________________

Work (       )__________________________

Cell (       )___________________________

E-mail address_______________________________________________

 

With whom does the student live?________________________________

 

Please list 2 additional numbers (other than mother and father) that we may contact in the event of an emergency.

 

Name_______________________    Name_________________________

Relationship__________________   Relationship___________________ 

Home (     )__________________    Home (     )__________________  

Work (     )___________________   Work (     )____________________

Cell (     )____________________   Cell (     )_____________________

 

In the event of an early school closing, how will your child get home?______________________________________________________________

___________________________________________________________________