Blue Information Card
Student's Last Name *
Student's First Name *
Student's Middle Name or Initial
Student's Date of Birth *
MM
/
DD
/
YYYY
Name of Parent/Guardian Student Resides With *
Relationship of Parent/Guardian to Student *
Parent's Preferred Language of Communication *
Parent/Guardian's Home Telephone *
Parent/Guardian's Cellular Telephone
Parent/Guardian's Work Telephone
Parent/Guardian's Email *
Parent/Guardian's Street Address *
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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