Student Contact Information Form
Bard Early College Student Contact Information Form
Sign in to Google to save your progress. Learn more
Who is completing this electronic form? *
If "Other"- Can you please tell us your relationship to the student?
Who is completing this form? (last and first name) *
What is today's date?
MM
/
DD
/
YYYY
Student last name: *
Student first name: *
Student middle name: *
Student birthday: *
MM
/
DD
/
YYYY
Student gender: *
Student street number (like 2915, the number of your home, not your phone number) *
Student Street Name
Student Apartment Number or other address identifiyer
Student city *
Student Zipcode: *
Mailing address- (if different from the street address)
Student preferred e-mail adress
Is the student Hispanic or Latino?
Clear selection
What is the students race or ethnicity?
Clear selection
Are you temporarily living with others due to lack of permanent housing, living in shelter, living in a hotel, or otherwise homeless?
Clear selection
First parent or guardian: parent/guardian first name *
First parent or guardian parent/guardian last name *
First parent or guardian relationship: *
First parent or guardian Home phone number *
First parent or guardian cell phone number *
First parent or guardian preferred language *
First parent preferred e-mail adress
Please tell us a little about the first parent/guardian's connection to the student:
Second parent or guardian: First name
Second parent or guardian: Last name
Second parent or guardian: relationship
Second parent or guardian: Home phone number
Second parent or guardian: Cell phone number
Second parent preferred e-mail adress
Second parent or guardian: At what telephone number would you like to receive text messages with important information from the district or school such as closings or upcoming events? Please remember that text messages charge may apply, depending on your cell phone plan. Please check with your provider.
Second parent or guardian: Preferred Language
Please tell us a little about the second parent/guardian's connection to the student:
In case of a medical or behavioral emergency, who should we call first? Please list name and telephone number. *
In case of a medical or behavioral emergency, who should we call if we are unable to reach the first emergency contact? Please list name and telephone number. *
In general, how is the student going to be getting to school? *
In general, how is the student going to be getting home from school? *
Car #1- If the student might be driving and parking a car to get to/from school, what is the make, model and color of the car?
Car #1- If the student might be driving and parking a car to get to/from school, what is the licence plate number of  car #1?  
Car #2- If the student might be driving and parking a car to get to/from school, what is the make, model and color of the car?
Car #2- If the student might be driving and parking a car to get to/from school, what is the licence plate number of  car #2?  
In general, do you anticipate the student will be having breakfast at school?
Clear selection
Where did the student attend 8th grade?
Where did the student attend school in April of last year?
Thank you for providing us with your emergency contact information. Please keep in mind that this form does not take the place of the BCPSS Student Contact Information Form. Have a great school year!  By clicking yes below to attest to the following: I am aware that this form does not take the place of the BCPSS Student Contact Information Form and data form this form does not update my contact information in the BCPSS Infinite Campus system, Parent Portal or other similar systems. I am aware that I am giving this information voluntarily. I consent for this information to be shared with faculty and staff of Bard High School Early College.   *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Bard Early Colleges. Report Abuse
Google Forms