Contact Information
Student Name: __________________________________________
Activities that you are involved in _________________________________
Mother’s (Guardian’s) Name (First and Last): _________________________________
Work phone: ______________________Cell #: ________________
Work email: ______________________________________________________
Home email: ______________________________________________________
Father’s (Guardian’s) Name (First and Last):________________________________ __
Work phone: ___________________________Cell ___________________
Work email: ______________________________________________________
Home email: ______________________________________________________
What is the best way/time to contact you?__________________________________
_____________________________________________________________________________
Please check all that apply:
o Access to the internet at home
o Can print from a computer at home
o In AVID
I have read Mrs. Peters’ rules and procedures. I understand them and will follow them.
Parent/Guardian Signature:______________________________________
Student Signature:_____________________________________________