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Parent Contact Information Form
8/20/2014

Parent Contact Information

 

PLASE 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?_______________________________________________________________________________________________________________________________________________________________________________