*This information will only be viewed by the assigned teacher and administration. (There is one question at the bottom requesting permission to share your name and email address with our Parent Teacher Organization.)
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Email *
Student First Name *
Student Last Name *
Grade Level *
Teacher *
Parent 1 - First Name *
Parent 1 - Last Name *
Parent 1 - Phone Number (xxx) xxx-xxxx *
Parent 1 - Email Address
Parent 2 - First Name
Parent 2- Last Name
Parent 2- Phone Number xxx-xxx-xxxx
Parent 2- Email Address
Internet *
Jefferson PTO - Parent Teacher Organization (Checking yes will allow them to share information. It does not mean you have to join.) *
Any additional information you would like to share about your child.
A copy of your responses will be emailed to the address you provided.
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