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Student

Info
Childs Name __________________________ Birthday (month/day/year) _______
Parents Names ______________________________________________________
Address _____________________________________________________________
Phone numbers: home ______________ cell ______________ work ____________
Email(s) _____________________________________________________________
How will your child get home? walk

car

bike

bus#______ daycare______

Person to call in case of an emergency___________________ phone ___________


Are there any medical needs or conditions of which I should be aware? (allergies,
asthma, etc.) __________________________________________________________
Student lives with: (Please check all that apply.)
Both parents
Single parent (circle one) Mother Father
Guardian (specify _______________________________)
Siblings (ages and schools attending) ________________________________
____________________________________________________________________
____________________________________________________________________
How long has your child attended our school? ______________________________
What other elementary schools has your child attended? ____________________
What are your long-term goals concerning your childs education? (e.g. graduate high
school, attend college, etc) ____________________________________________
What are your childs extra curricular activities? __________________________
____________________________________________________________________
What would you like for me to know about your child? _____________________
____________________________________________________________________

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