2019 MS54 NEW STUDENT FAMILY FORM
Dear Parents,

MS54 families are requested to fill out the information below so that we can communicate with you during the school year.

If you have any questions, please contact Parent Coordinator Anne McIntosh Pejovich at amcintosh6@schools.nyc.gov

Thank you for your help.

The Administration, Faculty, Staff & PTA of MS54
STUDENT INFORMATION
Student OSIS number - School ID number *
Student's First Name: *
Student's Last Name: *
Student's Primary Residence Telephone: *
XXX-XXX-XXXX
Student’s Address: *
PARENT/GUARDIAN #1 INFORMATION
Parent/Guardian #1 First Name: *
Parent/Guardian #1 Last Name: *
Parent/Guardian #1 Home Phone:
XXX-XXX-XXXX
Parent/Guardian #1 Work Phone:
XXX-XXX-XXXX
Parent/Guardian #1 Cell Phone:
XXX-XXX-XXXX
Parent/Guardian #1 Email: *
Parent/Guardian #1 Address:
(Leave blank if same as student address)
Would you like to volunteer to be a class parent?
Clear selection
PARENT/GUARDIAN #2 INFORMATION
Parent/Guardian #2 First Name:
Parent/Guardian #2 Last Name:
Parent/Guardian #2 Home Phone:
XXX-XXX-XXXX
Parent/Guardian #2 Work Phone:
XXX-XXX-XXXX
Parent/Guardian #2 Cell Phone:
XXX-XXX-XXXX
Parent/Guardian #2 Email:
Parent/Guardian #2 Address:
Would you like to volunteer to be a class parent?
Clear selection
Please enter your child's grade *
THANKS FOR YOUR HELP!
Please click on the SUBMIT button when you have completed the form.
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