Reopening Plan

Student Information Form Academic Year 2020-2021

Family Demographics Information

Student Information

Parent Information

Parent 1 (P1)

Translation Required P1
Permission to Text This Phone P1 *
Permission to Leave A Message at This Number P1 *

Parent 2 (P2)

Translation Required P2
Permission to Text This Phone P2 *
Permission to Leave A Message at This Number P2 *

Legal Guardian (if different from Parents)

Medical Information (please be specific)

Seizures? *
Cardiac Problems? *
Allergies to Food? (if yes list all foods) *
Allergies to Medications? (if yes list all medications) *
Allergies to Bee Stings, Environmental Allergens? (if yes list all allergens) *
Given at Home 1
Given at School 1
Given at Home 2
Given at School 2
Given at Home 3
Given at School 3
Given at Home 4
Given at School 4

Health Insurance Information

Preson(s) to Contact In Case of An Emergency