Health Disclosure
Email address *
Class Period *
Student Last Name (as recorded by the school) *
Your answer
Student First Name (as recorded by the school) *
Your answer
Parent/Guardian Name *
Your answer
Parent e-mail *
Your answer
Parent/Guardian Contact # *
Your answer
Do you give permission for student pictures/videos or work samples of be posted on the class webpage? *
I have read, understand, and accept Ms Johnson class disclosure, procedures, and expectations. *
Required
A copy of your responses will be emailed to the address you provided.
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