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Smithfield Elementary School Student Information
This form serves as our emergency contact form. Please fill out one form per child.
It is imperative we have accurate information whether in remote or in-person learning. Thank you!
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* Indicates required question
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
Child's Preferred Name
Your answer
Home Address
*
Your answer
BEST Phone Number to be reached
*
Your answer
Teacher (Last Name only)
*
Your answer
Birth Date (Month/Day/Year)
*
MM
/
DD
/
YYYY
Please list the adults with whom the student lives.
*
Your answer
Guardian 1 Name/Relationship
*
Your answer
Guardian 1 - BEST Phone Number
*
Your answer
Guardian 1 - BEST Email Address
*
Your answer
Guardian 1- Alternate Phone Number
*
Your answer
Guardian 2- Name/Relationship
*
Your answer
Guardian 2- BEST Phone Number
*
Your answer
Guardian 2- BEST Email Address
*
Your answer
Guardian 2- Alternate Phone Number
*
Your answer
Individuals with Permission to Pick Your Child up from School
This information will be used if/when we return to school under the B or B+ Remote plan.
Individual 1-Name/Relationship
*
Your answer
Individual 1 - BEST Phone Number
*
Your answer
Individual 2- Name/Relationship
*
Your answer
Individual 2- BEST Phone Number
*
Your answer
If your child has a food allergy, please list them below.
Your answer
Please list any other medical concerns/conditions.
Your answer
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