Justice League Contact Info

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Please complete the following form to allow us to stay in contact.

Student's Homeroom *

Bielinksi

Bienkievitz

Dewulf

Jorgensen

Student Last Name *

Student First Name *

Does your student go by a different name than their first name? Please tell us below.

Home Phone *

Parent/Guardian #1 Name *

Parent/Guardian #1 Cell Phone Number *

Parent/Guardian #2 Name *

Parent/Guardian #2 Cell Phone Number *

Mailing/Physical Residence Address (may be used to send home physical resources) *

Name of Neighborhood or Development (if applicable; ie. Bridge Point, etc.)? [if physical resources were dropped off] *

Parent/Guardian Email Addresses (please put a semi-colon, ; in between multiple email addresses) *

Preferred Method of Contact *

Phone

Text

Mail

Mrs. Bienkievitz is working on completing her National Board Certification. Please look over the attached permission form and respond below. https://www.nbpts.org/wp-content/uploads/Student_Release_Form_English.pdf *

I DO give permission for my student's work to be used and be recorded on video for the sole purpose of teacher certification.

I DO NOT give permission for my student's work to be used and be recorded on video for the sole purpose of teacher certification.

Our team would like to use Flipgrid to engage our students. Please read the following permission form and respond below. https://static.flipgrid.com/docs/Flipgrid_consent_form.pdf *

I DO give my student permission to participate in Flipgrid assignments.

I DO NOT give my student permission to participate in Flipgrid assignments.

I have read and understand the Teachers' Individual Intros and Expectations. *

Yes

I have emailed you a question

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