2023-2024 Contact Information Room 10

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Please use correct punctuation when filling out this form. Do not write in all caps or all small letters. It takes me a long time to fix the information when names, e-mails and phone numbers are not punctuated correctly. Please put None on any question that does not apply to you. Thank you!

Student's First Name *

Student's Last Name *

Student's Birthday (i.e., 8/18/2022 *

YYYY

Student's House *

Altruismo

Isibindi

Amistad

Reveur

My child is new; theydon't have a house yet

Home phone #. If none put N/A: Please use dashes (i.e., 123-456-7890 *

Mom's first and last name: Please use correct punctuation (i.e., Minnie Mouse) *

Mom's email *

Mom's cell phone # Please use dashes (i.e., 123-456-7890 *

Mom's work phone: If none put N/A Please use dashes (i.e., 123-456-7890 *

Dad's first and last name. Please use correct punctuation (i.e., Mickey Mouse) *

Dad's email *

Dad's work phone # Please use dashes (i.e., 123-456-7890 *

Dad's cell: Please use dashes (i.e., 123-456-7890 *

Complete Address *

Please check the correct box. *

Neither parent is fingerprinted or TB tested

Mom has a TB test on file in the office but not fingerprinting .

Dad has a TB test on file in the office but not fingerprinting .

Mom is fingerprinted AND has TB test on file in the office.

Dad is fingerprinted AND has a TB test on file in the office.

Required

I would be interested in being the Room Parent this year. *

Yes

I would be interested in being the Project Cornerstone Parent this year. *

Yes

I would be willing to help with projects that could be done at home. *

Yes

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