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Back to School Information Mrs. Treibel's class 2016-2017
Child’s Full Name:
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Child’s Preferred Name:
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Child’s Date of Birth:
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Parent/Guardian #1 Name:
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Parent/Guardian #1 Cell Number:
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Parent/Guardian #1 Email Address:
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Parent/Guardian #2 Name:
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Parent/Guardian #2 Cell Number:
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Parent/Guardian #2 Email Address:
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Home Address:
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Emergency Contact (in case parents are not available) Cell Number:
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Pertinent Medical Information (i.e.: allergies):
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How will your child regularly go home from school?Choose from 1. Bus (include Bus number) 2. Carpool 3: Walker 4: JAS 5. Van (Name of Van Service)
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Child’s Strengths and Weakness In/Out of the Classroom:
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Preferred email to be used for school/classroom correspondence (you may include more than one)
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Important information about your family: This information is completely confidential. It will be used to help me understand your family dynamics that will help guide my interactions and conversations in the classroom. Please include any information that you feel is important about your family. (Parents married, divorced, remarried, living with grandparents, etc.).
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Is there any person legally prohibited from visiting or picking up your child from school?
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PG Movie Permission:In case of inside recess or earned free time, students will have the option to watch PG animated movies. Please indicate if your child has permission to do so.
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