Parent/Guardian Information Form
Parent/Guardian First Name
Parent/Guardian Last Name
Please include all numbers by which I may reach you (home, work, cell, etc.)
Please submit the address by which you receive mail.
Parent/Guardian Email Address
If you do not have an email address, please leave a period "." in this space.
Is your child enrolled in the NIA afterschool program?
No, but I would like to know more about the program.
Does your child have any other afterschool activities in which they participate?
(swimming, dance, baseball, etc.) List any that apply. If none, write "none."
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?
What is your primary language spoken at home?
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