Fill in only the information you are Fill in only the information you are

willing/able to share. willing/able to share.

Student Last Name Student First Name Student Last Name Student First Name

Class Period (Circle One) Class Period (Circle One)

1A 2A 3A 4A 1B 2B 3B 4B 1A 2A 3A 4A 1B 2B 3B 4B
PARENT / PARENT / GUARDIAN PARENT / PARENT / GUARDIAN
GUARDIAN 1 2 GUARDIAN 1 2
Name (First & Last) Name (First & Last) Name (First & Last) Name (First & Last)

Relationship to Relationship to Student Relationship to Relationship to Student

Student Student

Home Phone Home Phone Home Phone Home Phone

Work Phone Work Phone Work Phone Work Phone

Cell Phone Cell Phone Cell Phone Cell Phone

Home E-mail Home E-mail Home E-mail Home E-mail

Work E-mail Work E-mail Work E-mail Work E-mail

I prefer contact by: I prefer contact by: I prefer contact by: I prefer contact by:
 Home Phone  Home Phone  Home Phone  Home Phone
 Work Phone  Work Phone  Work Phone  Work Phone
 Cell Phone  Cell Phone  Cell Phone  Cell Phone
 Home E-mail  Home E-mail  Home E-mail  Home E-mail
 Work E-mail  Work E-mail  Work E-mail  Work E-mail