PTO DIRECTORY EXCLUSION (OPTIONAL) 2024-2025

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As part of a PTO membership, members get a copy of a school-produced directory. The following information for each family will be included in the directory, unless this exclusion form is completed:

Student name and address, grade, teacher, Parent names, Primary Phone #, Primary Email

Please complete the form below ONLY if you wish to EXCLUDE some or all of your contact information. Note: Complete one per student.

If you would like your contact information included in the directory, you may disregard this form and no action on this form is needed.

EXCLUSION FORMS MUST BE COMPLETED NO LATER THAN FRIDAY, SEPTEMBER 6.

If an exclusion form has not been received by this date, we will interpret this as your permission to include your family’s contact information in the 2024-2025 Kloefkorn Student Directory.

Email *

Student Name (ex. Bill Kloefkorn) *

Student Grade *

Pre-K

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

Please include my students name & grade, but DO NOT include: (check all that apply) *

Address

Primary Phone Number

Primary Email

Please completely exclude all of my family's information and student name.

You may include all of the information above (if this is your choice, you do not need to complete this form)

Required

Electronic Signature *

Submit

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