Women in Charge 2018 - 2019 STUDENT DATA FORM / Contact Info
This form will provide the needed information we need to communicate with you this school year about Women in Charge events and news. If there is any question you are confused about please let us know. We will be happy to help.
Email address *
Student Member Last Name *
Student Member First name *
Grade *
Yes I would like to be a part of Women in Charge for the 2019-2020 school year and I am aware meetings are usually on Monday's after school (specific dates posted on womenincharge101.org) *
Homeroom Teacher *
Student Email Address *
Mother's Email Address
Father's Email Address
Mother's First and Last Name
Father's First and Last Name *
Student's Cell phone # (INCLUDE AREA CODE) *
Mother's Cell phone # (INCLUDE AREA CODE)
Father's Cell Phone # (INCLUDE AREA CODE)
Street Address (House or Apt # and street name) *
City *
zip code *
List any food allergies you have.
Health Issues we need to know about (This will be kept confidential)
This year I would love WIC to plan or have us... (fill in what you want/think).
A copy of your responses will be emailed to the address you provided.
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