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DSA All School Directory Form for 2016-17
Register to be included in the all school family directory for the 2016-17 year
Student Last Name
Your answer
Student First Name
Your answer
Student Major (Please mark one only)
Student Grade (for 2016-17 year - Please mark one)
Student Email (Optional; must have parental permission to include this in directory)
Your answer
Student Phone Number (Optional; must have parental permission to include in directory, in this format: 000-000-0000)
Your answer
Parent Permission to include student info in directory
Required
Parent Last Name
Your answer
Parent First Name
Your answer
Parent Email (must have at least 1 parent listed, with email, to be included in directory)
Your answer
Parent Phone in this format: 111-111-1111
Your answer
2nd Parent Last Name (optional)
Your answer
2nd Parent First Name (optional)
Your answer
2nd Parent Email (optional)
Your answer
2nd Parent Phone (optional, in this format: 222-222-2222)
Your answer
3rd Parent Last Name (optional)
Your answer
3rd Parent First Name (optional)
Your answer
3rd Parent Email (optional)
Your answer
3rd Parent Phone (optional, in this format: 333-333-3333)
Your answer
4th Parent Last Name (optional)
Your answer
4th Parent First Name (optional)
Your answer
4th Parent Email (optional)
Your answer
4th Parent Phone (optional, in this format: 444-444-4444)
Your answer
Please include the above information in the DSA All School Directory for 2016-17
Required
Please send the DSA Newsletter to all emails listed above
Required
Add any emails of people not listed above, who would like to receive the newsletter
Your answer
Comments/Questions
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