Info Sheet

Name of Student: _________________________________________      Class: ______________________

Student Cell Phone: ____________________________          Grade: ______________

Student e-mail Address: __________________________________________________

Parent(s) and/or Guardian(s)

First and Last Name, (h) Home Phone, ( c) Cell Phone, and e-mail Address

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

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Student Address

_______________________________________________________________________________________________

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StudentŐs Birthday: ________________________________

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Date                   Person Contacted    Type of Communication    Nature of Communication