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Incoming 6th Graders - Contact Info
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* Indicates required question
Email
*
Your email
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
Student's Middle Name
Your answer
Place of Birth
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Home Phone Number
*
Your answer
Home Address
*
Your answer
Student Lives with
*
Option 1
Mother
Father
Step mother
Step Father
Other:
Required
Parent' s Information (Name, Occupation, Work Address, Phone Number and Email Address)
*
Your answer
Step Parent's Information (Name, Occupation, Work Address, Phone Number and Email Address)
Your answer
Student's Siblings (List oldest to youngest, with DOB and school)
Your answer
Student's Present School
*
Buchanan-Verplanck Elementary School
FGL
Furnace Woods Elementary School
Other:
Student's Present Teacher
Your answer
Three (3) Emergency Contacts (Full Name, Relationship with student, Address, Phone Number). *This information needed in case parents/guardians cannot be reached.
*
Your answer
Any other information that would help us better educate your child
Your answer
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