5th Grade Student Information
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Preferred Name *
What name is your child normally called?
Student's Last Name *
Student's First Name *
Father's Name *
Last name, First name
Mother's Name *
Last Name, First Name
Student's Homeroom Teacher *
Student lives with? *
Preferred Phone Number *
Please provide a phone number at which we can reach you at any time.
Primary E-mail Address *
Please provide an email that is checked frequently as this is our primary form of communication!
Secondary E-mail Address
Secondary Phone Number
After-School Transportation *
How does your child go home on a daily basis?
Bus Number (if applicable)
What is your child's bus number?
Emergency Dismissal Transportation *
How will your child go home in case of emergency dismissal?
Is English the primary language spoken at home? *
If not, please list the primary language.
Do you have internet access at home? *
Are you interested in any of the following volunteer opportunities?
Student has permission to watch PG movies? *
School policy states that the students will only be shown "G" rated movies without permission from parents.  Many movies that we like to show to our students to enhance learning curriculum are "PG" rated.
What is your child's locker number? *
This will be the four digit locker number on the front of the locker.  This is NOT the student's locker combination.
What information about your child will help us help your child reach his or her fullest potential? *
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