Student Information

Student Name: ____________________________ Nickname: __________________________

Birthday: __________________________________ Allergies: ____________________________

Home Phone: ___________________________________________________________________

Home Address: _________________________________________________________________

_________________________________________________________________________________

Guardian Name (1): _____________________________________________________________

Relationship to student: __________________________________________________________

Cell Number: __________________________ Email Address: __________________________

Guardian Name (2): ____________________________________________________________

Cell Number: _________________________ Email Address: ___________________________

Relationship to student: __________________________________________________________

Does your child have any siblings here at school? Please list their name(s) and
grade(s):

_________________________________________________________________________________

_________________________________________________________________________________

People who can pick my child up from school:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

(Please continue on the back)

What goals do you have for your child this year?

_________________________________________________________________________________

_________________________________________________________________________________

What are your childs interests?

_________________________________________________________________________________

_________________________________________________________________________________

Do you have any concerns for this year?

_________________________________________________________________________________

_________________________________________________________________________________

Is there anything else you would like me to know?

_________________________________________________________________________________

_________________________________________________________________________________