Confidential Resource Checklist

Dear Parents/Guardians,

A number of resources exist to help Park Hill School District families. If your family could benefit from any of the resources listed below, please check the service(s) you feel would be helpful. All information received and any service provided is kept strictly confidential. We look forward to providing support to your family. Upon return of this completed form, the School Social Worker will either send you information or applications based on the needs indicated, or contact you directly for further information. By submitting this form, you give the School Social Worker permission to contact you and to provide referrals to community resources.If you have any questions, please feel free to contact Lakeview School Social Worker, Jill Hazell at or (816) 359-6450.
Email address *
Lakeview Student(s) Last name, First name: *
Your answer
Guardian Last name, First name *
Your answer
If you have additional children, please add them here:
Your answer
Best phone number to reach you: *
Your answer
Best time of Day to Call:
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