Child's First Name

Child's Last Name

Lupin Hill Elementary School
Communication Consent Form
This form will be used by your child's Room Parent to pass along pertinent classroom and school information to you.
If you do NOT want this contact information to be published in the Classroom Roster and School Directory
please check the box at the bottom of this form.
Child's Address
Child's Grade Child's Home #
Mother's Name
Mother's Address
Mother's E-mail
Mother's Mobile #
Father's Name
Father's Address
Father's E-mail
Father's Mobile #
I DO NOT want my child's information to be placed in the classroom or school directory. I understand that I
can not have my child's information in one but not the other.

if same as child write "SAME"
if same as child write "SAME"
Print Form