SSMS Parent Contact Form
Parents, please fill this form out so that we can reach you with any concerns that may come up during the school day. If a question does not apply, please disregard and go to the next question.
Student Last Name *
Student First Name *
How would you describe the students ability to connect to the internet daily and participate virtually via the Remote Learning plan.
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Mother's Last Name
Mother's First Name
Mother's Day Time Contact #
Mother's Night Time Contact #
Mother's Email (please only input if email account is active)
Please retype Mother's Email
Father's Last Name
Father's First Name
Father's Day Time Contact #
Father's Night Time Contact #
Father's Email (please only input if email account is active)
Please retype Father's Email
Guardian 1 (or close relative) Last Name (if applicable)
Guardian 1 (or close relative) First Name (if applicable)
Guardian 1 (or close relative) Day Time Contact #
Guardian 1 (or close relative) Night Time Contact #
Guardian 1 (or close relative) Email (please only input if email account is active)
Please retype Guardian 1 (or close relative) Email
Guardian 2 Last Name (if applicable)
Guardian 2 (or close relative) First Name (if applicable)
Guardian 2 (or close relative) Day Time Contact #
Guardian 2 (or close relative) Night Time Contact #
Guardian 2 (or close relative) Email (please only input if email account is active)
Please retype Guardian 2 (or close relative) Email
Who is the primary contact for school concerns?
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If during the day, your child becomes Ill; who should be contacted first? (if other, please type in name and contact #)
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If this contact can not be reached, who should then should be called? (if other, please type in name and contact #)
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If we are dismissed early for weather or other similar instances; in what way would your child be dismissed?
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