Request edit access
Student Information Sheet
Please complete this form in its entirety. Complete one per child.
Email address *
Student's last name *
Your answer
Student's first name *
Your answer
Date of Birth *
Your answer
Student's Primary Residence (address, city, state, zip) *
Your answer
Student resides with:
Your answer
Mom's Cell *
Your answer
Dad's Cell
Your answer
Please list anyone who has permission to pick up your child from school, and their relationship to the child.
Your answer
Emergency Contact if parents cannot be reached: (name, then relationship) *
Your answer
Notes regarding emergency contact:
Your answer
Please list how your child will usually arrive at school: *
Required
Please list how your child will usually leave school: *
Required
Any notes regarding arrival/ dismissal
Your answer
Does your child have any of the following? *
Required
Please list and/ or describe treatments for any of the above checked boxes.
Your answer
Health Insurance Co and Policy # (If child is not covered by insurance, please put n/a)
Your answer
I understand that all medications must be brought to school in its original container by the parent or guardian and turned over to the teacher. *
I am the parent/ guardian of the child listed above and I grant WEVS staff the authority to contact the rescue squad for transport to the hospital on behalf of the child in case of an emergency and the parent cannot be reached. *
Name of parent or guardian completing this form *
Your answer
Any additional notes that should be on the emergency student information form:
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Water's Edge Village School. Report Abuse - Terms of Service