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 *
Student's Last Name *
Current Grade *
Current Teacher's Name
Student Date of Birth *
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/
DD
/
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Student Gender *
Mother's Name
Mother's Email address
Mother's Primary Phone Number
Mother's Secondary Phone Number
Father's Name
Father's Email address
Father's Primary Phone Number
Father's Secondary Phone Number
Address where Student lives *
Emergency Contact #1 Name (other than parent/guardian)
Emergency Contact #1 Phone Number
Emergency Contact #2 Name (other than parent/guardian)
Emergency Contact #2 Phone Number
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