Student’s name: ________________________________________
Family member #1: ____________________
Relation to student: ___________
Home phone : ___________ Work phone: _____________
Cell phone: _________________ E-mail
address (please print): _________________
How would you prefer to be
contacted? ___Home___Work___Cell phone___E-mail
When would you prefer to be
contacted? (days/times) _________________________
If you do not have access to phone or e-mail, how may I contact you? ____________
________________________________________________________________
Family member #2: ____________________
Relation to student: ___________
Home phone : _________________ Work phone: _____________
Cell phone: _________________ E-mail
address (please print): _________________
How would you prefer to be contacted? ___Home ___Work___Cell phone___E-mail
When would you prefer to be
contacted? (days/times) _________________________
If you do not have access to
phone or e-mail, how may I contact you? ___________________________________________________________________________
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