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Student Information Form
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* Indicates required question
Email
*
Your email
Child's first name
*
Your answer
Child's last name
*
Your answer
Child's nickname (if used daily)
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Where does your child live?
*
With mother and father
With mother only
With father only
Shared custody (mom/dad)
Grandparents/Guardian
Other:
Primary Residence Address
*
Your answer
Mother's first and last name
*
Your answer
Mother's home number
Your answer
Mother's email
*
Your answer
Mother's cellphone number
*
Your answer
Mother's work number
*
Your answer
Mother's Occupation
Your answer
Father's first and last name
*
Your answer
Father's home number (type "same" if it is the same as the mother's)
Your answer
Father's email
*
Your answer
Father's cell number
*
Your answer
Father's work number
*
Your answer
Father's Occupation
Your answer
Siblings (name/age/school)
Your answer
Child's First Grade Teacher
*
Mrs. Collins
Mrs. Williams
Mrs. Hanby
New to SPN
Does your child have any of the following (check all that apply):
*
Medical condition
Allergy
None of the above
Other:
Required
If you checked above, please give more information
Your answer
How does your child go home? (Check all that apply)
*
Bus
Aftercare
Mom/dad pickup
Grandparent/babysitter pickup
Other:
Required
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