Instructions:
Above: Fill in student's name.

Below: Please fill-out completely.

Thank you for your prompt reply.

1)
Student's Name:

2)
Parent/Guardian's Name:
(state relationship to student)

3)
Best time to be reached during the day by phone:

4)
Best phone number to use to reach during the day (please indicate if
this is a home phone, cell phone, or work phone):

5)
E-mail of parent/guardian:

6)
Anything the teacher should know about your child: