Contact Information

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Contact Information

Please fill out the below information.

Email *

Student's Name (Last, First) *

Please select your child's homeroom number. *

203 - Mr. Andersen

204 - Mrs. Dietrich

206 - Mrs. Kurtzman

Names of Parents/Guardians *

Email #1 *

Email #2 *

Best Number to Reach You (You may list more than one.) *

Please check one... *

I give permission for my child's photo, work, and name to be posted on the class website AND in school.

I give permission for my child's photo, work, and name to be posted ONLY in the classroom.

I DO NOT give permission for my child's photo, work, and name to be posted either online or in the classroom.

Other (Please see next question)

Required

If you selected "other" in the question above, please clarify your selection in the space below.

Any information about your child you feel the teachers should know.

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