Parent Contact Survey 2019/2020

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Please provide the following information to ensure you always know what is going on with your student's musical career!

Student Information

Student's Name (LAST, FIRST) *

Student's/Primary Guardian Home Address *

Student's Band: *

Select one. Percussionist may select 2

Beginning Band- Year 1

Intermediate Band - Year 2

Advanced Band - Year 3

Percussion Ensemble - ONLY PERCUSSIONIST

Required

Guardian Information

Primary Guardian Name: (LAST, FIRST) *

Primary Guardian Language of Choice: *

English

Spanish

Primary Guardian Email: *

PLEASE provide an email you use. If you do not read the emails sent home regarding homework, date changes, and events I cannot be held accountable for your student's absence! I will also use this email to register you for Google Classroom.

Primary Guardian Phone Number: ### - ### - #### *

PLEASE provide a phone number that can be used to contact you!

Secondary Parent/Guardian Information (Optional)

Secondary Guardian Name: (LAST, FIRST)

OPTIONAL

Secondary Guardian Language of Choice:

Optional

English

Spanish

Clear selection

Secondary Guardian Email:

Optional

Secondary Guardian Phone Number: ### - ### - #### *

Optional

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This form was created inside of Shelbyville Central Schools.