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 *
Your answer
Student Member First name *
Your answer
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 *
Your answer
Student Email Address *
Your answer
Mother's Email Address
Your answer
Father's Email Address
Your answer
Mother's First and Last Name
Your answer
Father's First and Last Name *
Your answer
Student's Cell phone # (INCLUDE AREA CODE) *
Your answer
Mother's Cell phone # (INCLUDE AREA CODE)
Your answer
Father's Cell Phone # (INCLUDE AREA CODE)
Your answer
Street Address (House or Apt # and street name) *
Your answer
City *
zip code *
List any food allergies you have.
Your answer
Health Issues we need to know about (This will be kept confidential)
Your answer
This year I would love WIC to plan or have us... (fill in what you want/think).
Your answer
A copy of your responses will be emailed to the address you provided.
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