<p> Please fill out one form per child </p><p>Student Information Sheet</p><p>Last Name ______First Name ______Middle I. ___</p><p>Preferred Name/Nickname: ______Grade ______</p><p>Home Phone______Emergency Phone ______</p><p>Birthday ______(please include year)</p><p>Parent or Guardian ______Relationship: ______</p><p>Parent or Guardian ______Relationship: ______</p><p>Parent or Guardian Work Phone: ______</p><p>Home Address ______</p><p>City ______State _____ Zip Code ______</p><p>*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! </p><p>Emergency Pick ups </p><p>1. Name ______Phone ______Relationship______</p><p>2. Name ______Phone ______Relationship______</p><p>3. Name ______Phone ______Relationship______</p><p>4. Name ______Phone ______Relationship______</p><p>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: ______</p><p>Must be filled out and turned in By no later than March 2, 2015 Please fill out one form per child </p><p>Name: ______</p><p>Student Interest Survey</p><p>Five years ago … ______.</p><p>Five years from now … ______.</p><p>I love when … ______.</p><p>I hate when … ______.</p><p>The farthest I have ever traveled from home is … ______.</p><p>My favorite place in the world is … ______.</p><p>I admire ______because ______</p><p>______.</p><p>What is a good book you have read and why did you like it?______</p><p>______</p><p>Tell me about a good movie you’ve seen recently and why you liked it. ____</p><p>______</p><p>What is your favorite kind of music? ______</p><p>What is your favorite sport? ______</p><p>What are two common activities you do when you get home? ______</p><p>______</p><p>What wish do you have for someone else? ______</p><p>______</p><p>I daydream about … ______.</p><p>I’m curious about … ______.</p><p>Must be filled out and turned in By no later than March 2, 2015 Please fill out one form per child </p><p>The title of a book about my life would be … ______.</p><p>Must be filled out and turned in By no later than March 2, 2015</p>