Parent/Guardian Information Form
Student Name *
Your answer
Class *
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Phone Numbers *
Please include all numbers by which I may reach you (home, work, cell, etc.)
Your answer
Address *
Please submit the address by which you receive mail.
Your answer
Parent/Guardian Email Address *
If you do not have an email address, please leave a period "." in this space.
Your answer
Is your child enrolled in the NIA afterschool program? *
Choose one
Does your child have any other afterschool activities in which they participate? *
(swimming, dance, baseball, etc.) List any that apply. If none, write "none."
Your answer
How would you like to be contacted in regards to your child's perfromance and behavior? *
Choose your BEST method of communication.
Is there any information that you would like me to know about your child and/or your family? *
Your answer
What is your primary language spoken at home? *
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