Student Information Sheet

Please fill out one form per child

Last Name ______First Name ______Middle I. ___

Preferred Name/Nickname: ______Grade ______

Home Phone______Emergency Phone ______

Birthday ______(please include year)

Parent or Guardian ______Relationship: ______

Parent or Guardian Work Phone: ______

Home Address ______

City ______State _____ Zip Code ______

*If there is an emergency please list any Relative’s/Friends who can pick your child up. If a person is not listed, and is then sent to pick the student up. We will NOT release your child! No exceptions!

Emergency Pick ups

1. Name ______Phone ______Relationship______

If you have a medical issue that I should be aware of, or if you have any other questions or concerns, please include them here: ______

Must be filled out and turned in By no later than March 2, 2015 Please fill out one form per child

Name: ______

Student Interest Survey

Five years ago … ______.

Five years from now … ______.

I love when … ______.

I hate when … ______.

The farthest I have ever traveled from home is … ______.

My favorite place in the world is … ______.

I admire ______because ______

______.

What is a good book you have read and why did you like it?______

______

Tell me about a good movie you’ve seen recently and why you liked it. ____

______

What is your favorite kind of music? ______

What is your favorite sport? ______

What are two common activities you do when you get home? ______

______

What wish do you have for someone else? ______

______

I daydream about … ______.

I’m curious about … ______.

Must be filled out and turned in By no later than March 2, 2015 Please fill out one form per child

The title of a book about my life would be … ______.

Must be filled out and turned in By no later than March 2, 2015