Parent Contact Form - Room 101 - 2018-19
Child's First Name *
Your answer
Child's Last Name *
Your answer
Nickname
Your answer
Child's Birthday *
MM
/
DD
/
YYYY
Parent 1 Name (first and last) *
Your answer
Parent 1: How would you like to be addressed (first or last name?)
Your answer
Parent 1 Phone (cell) *
Your answer
Parent 1 Phone (home)
Your answer
Parent 1 Phone (work)
Your answer
Parent 1 Email Address *
Your answer
Parent 2 Name (first and last)
Your answer
Parent 2: How would you like to be addressed (first or last name?)
Your answer
Parent 2 Phone (cell)
Your answer
Parent 2 Phone (home)
Your answer
Parent 2 Phone (work)
Your answer
Parent 2 Email Address
Your answer
Who should I contact first in case of emergency? *
Your answer
Any other people doing pick-up (nanny, grandparent). Please provide name and phone number.
Your answer
Will your child be riding the bus? Please specify morning, afternoon or both.
Your answer
What days will your child be riding the bus home in the afternoon?
Will your child be attending Neighborhood Boys and Girls Club (NBGC)?
Your answer
What days will your child be attending NBGC?
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This form was created inside of Chicago Public Schools.