Student Contact Information Form
Please fill out this form to make sure our system is up to date with your information.
Triad Math & Science Academy Elementary Campus
Student's First Name *
Your answer
Student's Last Name *
Your answer
Current Grade *
Current Teacher's Name
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Student Gender *
Mother's Name
Your answer
Mother's Email address
Your answer
Mother's Primary Phone Number
Your answer
Mother's Secondary Phone Number
Your answer
Father's Name
Your answer
Father's Email address
Your answer
Father's Primary Phone Number
Your answer
Father's Secondary Phone Number
Your answer
Address where Student lives *
Your answer
Emergency Contact #1 Name (other than parent/guardian)
Your answer
Emergency Contact #1 Phone Number
Your answer
Emergency Contact #2 Name (other than parent/guardian)
Your answer
Emergency Contact #2 Phone Number
Your answer
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