Parent Contact Information
Please fill out this form as soon as possible after the beginning of the new school year. This will help me contact you in case of emergency, illness of your child, or any questions or concerns that I may have.
Email address *
Class Period that the student has Reading with me.
Clear selection
Child's preferred name(what he or she would like to be called), and last name *
Your name *
Your relationship with the student. *
Required
Please add a current telephone/mobile number that is best to contact you with. *
Please add a second person that I can reach in case you are not available. *
Please add the secondary person's most dependable contact number. *
Does your child have any health concerns that I need to be aware of? This may include severe allergies, asthma, or an ongoing illness that requires frequent visits to the nurse. You do not have to describe the illness, but I would like to be aware that your child needs to visit the nurse often. *
Does your child have any behavior concerns that I need to be aware of? *
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