Form Sample

Teacher Information
Teacher Name:
Teacher Email:
Teacher Phone Number:
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Email is the preferred way to reach me as opposed to a phone call as I am teaching during most of the day and here selectively before and after school.
Student Information
Please fill out all information below.
Student Name:*
Class Hour:*
Parent?Guardian (first & last name):*
Relation:*
Email Address:*
Phone Number:*
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Please state anything you would like for me to know about your child or any questions or concerns that you haye:
Student Signature*
Parent Signature*