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Emergency Contacts and Dismissal Survey
Due Date: FRIDAY, 9/4
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* Required
Parent Name: ---- Nombre de padre o madre:
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Your answer
Your Student/s’ Name (include all students) ---- Nombre de su estudiante/es:
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Your answer
Your Student/s' Grade ----Grado de su estudiante:
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Your answer
Home Address - - - - Dirección de domicilio
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Your answer
Parent Email - - - - Correo electrónico del padre
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Your answer
Emergency Contact # 1 Full Name (should be someone other than parent): ------- Contacto de emergencia #1 nombre completo (tiene que ser alguien aparte del padre/madre)
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Your answer
Emergency Contact # 1 Relationship to Student (i.e. Aunt): ----- Relacion al estudiante del contacto de emergencia #1 (ejemplo, tia) :
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Your answer
Emergency Contact # 1 Phone Number: ----- Numero de telefono del contacto de emergencia #1:
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Your answer
Emergency Contact # 1 Email: ----- Correo electronico del contacto de emergencia #1:
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Your answer
Emergency Contact # 2 Full Name (should be someone other than parent): ------ Contacto de emergencia #2 nombre completo (tiene que ser alguien aparte del padre/madre)
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Your answer
Emergency Contact # 2 Relationship to Student: ------ Relacion al estudiante del contacto de emergencia #2 (ejemplo, tia) :
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Your answer
Emergency Contact # 2 Phone Number: ------- Numero de telefono del contacto de emergencia #2:
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Your answer
Emergency Contact # 2 Email: ------ Correo electronico del contacto de emergencia #2:
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Your answer
At least two phone numbers to reach parents: ----- Dos numeros de telefono donde podemos contactar a los padres:
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Your answer
List of anyone that is allowed to pick student up. For example, Maria Colombero, student's aunt 713-555-8775 ------ Lista de personas que tienen permiso para recoger a su hijo/a. Por ejemplo, Maria Colombero, tia de estudiante, 713-555-8775.
*
Your answer
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