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

_________________________________________________

Student Name (Print)

_________________

Date

_________________________________________________ _________________

Parent/Guardian Signature Date

_________________________________________________

Parent/Guardian Name (Print)

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