STUDENT INFORMATION FORM

Child's Name * Nickname is fine.

Child's Date of Birth * mm/dd/yyyy

Child's Address * Street, City, Zip

Home Phone # * Please remember to include the area code.

Child's Email This will allow for interactive assignments. All emails sent to child will be copied to parents.

Mother's Name Include last name if different than child's.

Mother's Address If different than child's

Mother's Home Phone If different than child's

Mother's Cell and/or Work Phone Indicate cell and/or work.

Mother's Email If different than child's

Father's Name Include last if different than child's

Father's Address If different than child's

Father's Home Phone If different than child's

Father's Cell and/or Work Phone Indicate cell and/or work.

Siblings at Creek View? Please include name and teacher.

Father's Email If different than child's and mother's

Afternoon Transportation Please include bus #, daycare, walker or carpool.

Medical and Other Information Include allergies and diet restrictions.