Army Family Team Building Level III

Family Readiness Group Leadership

Sample Newcomer’s Information Sheet

In case of an emergency, the unit needs to know who you would like for us to contact. Please
provide the following information so we can help you if you are unable to help yourself.

1. Full Name and Rank of Soldier:

Unit Platoon Squad

2. Are you married? Yes No (circle)

(if no, answer #3 with family member you wish to receive newsletters and information from the unit)

3. Name of spouse or family member:

Mailing Address:

City, State, Zip:

Home Phone: Work Phone: Cell Phone:

Email Address:

4. Do you have children? Yes No (circle)

Is your spouse pregnant at this time? Yes No Due Date:

Child’s Name: Age:

School/Day Care:

Child’s Name: Age:

School/Day Care:

Child’s Name: Age:

School/Day Care:

Child’s Name: Age:

School/Day Care:

Child’s Name: Age:

School/Day Care:

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Army Family Team Building Level III

5. Does your spouse and or child/children plan to leave the area during a deployment?

Yes No (Circle)

If yes, please provide contact information

Address:

City, State, Zip

Phone Number:
Does your spouse have a driver’s license? Yes No
Does your spouse have access to a car? Yes No

What is your spouse’s first language? _____________________________________

Is an interpreter necessary? Yes No

Are there any family pets in the home? Yes No

If you or your spouse were to get sick or need assistance, who in the local area would you like for us
to notify? This person should be close to the family and be able to help with the children. This person
should be on all paperwork with schools and daycare centers as an emergency contact. This way if
your spouse cannot pick up the children, there is a back-up plan already in place and we can notify
that person for assistance.

Name:

Home Phone: Work Phone: Cell Phone:

Email Address:

Do any of your family members have special needs? YES NO (circle)

Explain:

Note: Include the Privacy Act statement on your Information Sheet. As a Soldier fills out this
sheet for his/her family, inform him/her that this information will be made available to the FRG
for official purposes only.

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Army Family Team Building Level III

Privacy Act Statement

Here is an example of the Privacy Act Statement

AUTHORITY: Title 10, United States Code, Section 3013.

PRINCIPAL PURPOSE(S): The personal information requested will be used to

compile a Family Readiness Group (FRG) Membership Roster and/or Phone Tree.

ROUTINE USE(S): Any information you provide may be disclosed to key leaders
within the unit FRG or in accordance with the DoD “Blanket Routine Uses” set forth at
the beginning of the Army’s compilation of system of records notices.

DISCLOSURE: Disclosure is voluntary.

My personal information may be included on a FRG Membership Roster and/or Phone

Tree. I understand that I may withdraw this consent at any time.

Printed Name/Signature

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