Parent Information Form

Dear Parents,

I am attempting to use e-mail to contact you and allow you to contact me in a more accessible manner. Please fill out this form and submit it so that I may use this information to correspond with you regarding your child.

Student Information:

Student Name E-mail

Class:
Class Period:

*Student Name*		*E-mail*
*Class:*		*Class Period:*

Parent (1) Information:

Name

Address
Zip

Home Phone E-mail

Work Phone website

*Name*
*Address*		*Zip*
*Home Phone*		*E-mail*
*Work Phone*		*website*

Parent (2) Information:

Name

Address
Zip

Home Phone E-mail

Work Phone website

*Name*
*Address*		*Zip*
*Home Phone*		*E-mail*
*Work Phone*		*website*

NOTE: By submitting this form you agree that I may use this information to contact you in regards to your child. This form is being submitted via e-mail. Your browser may state that this is a security risk. I will not be selling your e-mail address, and I will not give out your address to anyone else unless you ask me to.
- D. Goettman

Back to Mr. G's Home Page

Hosted by www.Geocities.ws