Student Data

This form is sent home for parents to verify the information that a student has completed.

Please do NOT enter (write) any area codes unless it is something OTHER than 409.

 

Roll #_____ Name: ______________________ Period ____        Parent Initials _____ (if requested)

Student Data
Print small and neat, or circle response as appropriate!

Period: 1 2 3 4 5 6 7        Group Code:         1               2                          I.D. #: ____________
Lunch:   1    2     3                                    (semester one only) (all year)

Last:__________________ First: _____________ 
 Age: __________________ Birth date:    /     /

Grade: 9 10 11 12
 

Street address:_________________________ Zip:        ______________

Home Phone:  ______________ Student Cell: _______________ Studentís E-mail: ____________________
Mother or Other: _________________________ Occupation/Employer: _____________________________
   Work Phone: _________________ Cell Phone: _________________ Motherís Email: _________________
Father: _________________________ Occupation/Employer: ______________________________________
   Work Phone: _________________ Cell Phone: _________________ Fatherís Email: _________________
Camera Model #: ___________ Computer Type: ______________ Internet @ home:   Y  or  N                  
Extracurricular activities are you involved in:
Do you have a job, if so where and when:   


Notes (optional): ______________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

This form is due back within two (2) days after receiving it.

Failure to return it complete (with parent initials) on time may result in parent contact and/or after-school teacher detention.
 

Please also see:

Student/Parent Agreement to Procedures and Permission to Use Equipment Form

 

Please email me if you have any questions.

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