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Parent Information Form
Parents,
Thank you for providing this information. It is for my use only, and I will keep it confidential.
Julie Cox
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* Indicates required question
Child's Preferred Name
*
Your answer
Child's Last Name
*
Your answer
Parent 1 Name
*
Your answer
Parent 1 Email
*
Your answer
Best Phone Number to Reach Parent 1
*
Your answer
Parent 2 Name
Your answer
Parent 2 Email
Your answer
Best Phone Number to Reach Parent 2
Your answer
Parent 3 Name
Your answer
Parent 3 Email
Your answer
Best Phone Number to Reach Parent 3
Your answer
Parent 4 Name
Your answer
Parent 4 Email
Your answer
Best Phone Number to Reach Parent 4
Your answer
Emergency Contact Name
Please make sure this is someone other than parents already listed, who may be contacted in an emergency if parents cannot be reached.
Your answer
Emergency Contact Phone Number
Your answer
Child's Regular Dismissal Plan
*
I will follow this plan unless I have written instructions from you to do otherwise.
Cambridge Carpool
Heathermoor Carpool
Extended Day Program
Walker
Other:
Carpool Number
Please provide carpool number even if your child usually walks home. We will need it on bad weather days.
Your answer
Should I send your child directly to an after-school activity on a regular basis?
Ex: music on Tuesdays, dance on Mondays, etc.
Your answer
Child's T-shirt size
*
Each child will receive a grade level t-shirt. There is no additional cost to you.
Youth Small
Youth Medium
Youth Large
Adult Small
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