B-H School Shutdown Needs Questionnaire
Please complete this form to help Bertha-Hewitt School District assess the needs of our families during the COVID-19 school shutdown period. Fill out this questionnaire ONLY if you did NOT fill out a paper copy that was sent to school. Please fill out one questionnaire per student. Thank you!
Email address *
Student's Name *
Your answer
Student's Cell Phone Number
Your answer
Student's Bus #
Your answer
Parent/Guardian's Name *
Your answer
Parent/Guardian's Cell Phone (or other) Number
Your answer
Email address of Parent of K-4th Grade Student
Your answer
Food Delivery! *
Required
Only if you answered YES to wanting food delivered, please provide a consistent address for food delivery.
Your answer
Technology Needs! *
Required
Medical/Emergency/School Personnel : Do you work in the medical field, or as a first responder or emergency worker, or are you a Bertha-Hewitt School Employee AND NEED childcare for your child(ren)? *
Required
If you answered YES to needing childcare, please list the name and teacher of your child.
Your answer
If you are healthcare/emergency personnel and your child will be needing childcare please indicate the time you will be dropping off and picking up your child.
Your answer
My child will need transportation to the school for childcare (we will contact you regarding pick up and drop off times).
By answering YES below, I am consenting receipt of food. *
Required
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