2021-2022 Instruction Mode Survey
Please fill out this form if you are interested in having a virtual option for your student(s) next year. If you do not complete the form, the district will assume that you are planning to send your student to school for live instruction in the 2021-2022 school year.
Sign in to Google to save your progress. Learn more
Your first name *
Your last name *
Phone Number *
Address *
Relationship to child(ren) *
Name of Child 1 *
My preference for receiving instruction for child 1 *
Grade of Child 1 *
Name of Child 2
My preference for receiving instruction for my child 2
Clear selection
Grade of Child 2
Clear selection
Name of Child 3
My preference for receiving instruction for my child 3
Clear selection
Grade of Child 3
Clear selection
Name of Child 4
My preference for receiving instruction for child 4
Clear selection
Grade of Child 4
Clear selection
Name of Child 5
My preference for receiving instruction for child 5
Clear selection
Grade of Child 5
Clear selection
Name of Child 6
My preference for receiving instruction for child 6
Clear selection
Grade of Child 6
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Bristol Borough School District.

Does this form look suspicious? Report

Google Forms