Information Sheet

Student Information:

Full Student Name: __________________________________________________________________________

Nickname: _________________________________________________________________________________
Date of Birth: __________________ Languages Spoken at Home:_____________________________________
Medical Concerns/Allergies: ___________________________________________________________________
Student accomplishments and/or concerns: _______________________________________________________
__________________________________________________________________________________________
Hopes and Dreams for my child: ________________________________________________________________
Other Notes: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Parent/Guardian 1 Contact Information: *Primary*

Name : ______________________________________________ Relation/Title: _________________________
Phone:________________________ Email: _______________________________________________________
Preferred contact:

Email

Phone

Yes, I would like to volunteer in my childs classroom. Please Note: Fill out Miss Ks Volunteer Sheet .

Parent/ Guardian 2 Contact Information:

Name : ______________________________________________ Relation/Title: _________________________
Phone:__________________________ Email: ____________________________________________________
Preferred contact:

Email

Phone

Yes, I would like to volunteer in my childs classroom. Please Note: Fill out Miss Ks Volunteer Sheet.

HOW WILL I GET HOME?

Which Days of the Week?

Walking with/to: ___________________________

TH

Pick Up by: ___________________________

TH

Bus

_______________________________

TH

Other: _______________________________

TH

**If any of this information changes please let the office know, as well as sending an email or note to Miss K. Thanks!**