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Blue Information Card
Student's Last Name
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Student's First Name
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Student's Middle Name or Initial
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Student's Date of Birth
MM
/
DD
/
YYYY
Name of Parent/Guardian Student Resides With
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Relationship of Parent/Guardian to Student
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Parent's Preferred Language of Communication
Parent/Guardian's Home Telephone
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Parent/Guardian's Cellular Telephone
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Parent/Guardian's Work Telephone
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Parent/Guardian's Email
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Parent/Guardian's Street Address
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Parent/Guardian's Borough of Residence
List below the names and phone numbers of up to three (3) persons who may be called in case of emergency or if the child is sick at school.
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