Contact Information: 2019 - 2020
Student's Last Name, First Name *
Site Student is assigned to for 2019 - 2020 *
EC's (Teacher) Name
Person to Contact in the Event of an Emergency *
Emergency Contact Number *
List the people that can pick up your child, separate each name with a comma (,). *
List Allergies your child has, if none please write none: *
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