Name of Student ________________________________ Block ________ MS. GRIGGS

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Name of Student ________________________________
Block ________
MS. GRIGGS
Parent/Guardian 1:
Name:_____________________________________________________________
Relationship to student:________________________________________________
Best phone number to reach you at during the day: __________________________
Circle one: Is it a cell phone
home phone
work phone
Parent/Guardian 2:
Name:_____________________________________________________________
Relationship to student:________________________________________________
Best phone number to reach you at during the day: __________________________
Circle one: Is it a cell phone
home phone
work phone
*IMPORTANT* Is there any illness, disability, behavior issue, etc that I, as a teacher, need to
be aware of to better serve your child? (Examples: dyslexia, ADD, poor eyesight or hearing,
etc)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Please read and sign the following...
“I have read and understand the policies set forth in Ms. Griggs’ syllabus and understand that I
will be held accountable to them as well as to all policies set forth by Anderson 5 Career
Campus.”
_________________________________________________
Student Signature
_________________
Date
_________________________________________________
Student Name (Print)
_________________________________________________
Parent/Guardian Signature
_________________________________________________
Parent/Guardian Name (Print)
_________________
Date
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