Parent Contact Information
___________________________________ ____________________________________
Student’s Last Name Student’s First Name
__________________________________________________
Mother’s Name
__________________________________________________
Mother’s Address
_______________________________ ____________________________________
Mother’s HOME Phone Number Mother’s WORK/CELL Phone Number
_____________________________________________________
Email Address
_____________________________________________________
Father’s Name
_____________________________________________________
Father’s Address (If Different)
_______________________________ ____________________________________
Father’s HOME Phone Number Father’s WORK/CELL Phone Number
______________________________________________________
Email Address
Allergies?___________________________________________________________________
_________YES, allowed to watch “G,” “PG,” and “PG—13” movies
_________NO NOT ALLOWED!
_________YES, can be in class pictures—NOT for publication—Just classroom fun.
_________NO, CANNOT BE IN ANY PICTURES