Spotswood High School - Rockingham County Public Schools

A Rockingham County Public School
SPOTSWOOD HIGH SCHOOL
368 Blazer Drive, Penn Laird, Virginia 22846
540-289-3100 • Fax 540-289-3301
The following information is required to enroll a student at Spotswood High School:
D Birth Certificate
D Custody Papers (If student does not reside with a natural parent.)
D Proof of Residency (see attached sheet for requirements)
D Immunizations - documentation must be signed by the doctor or nurse.
D Grades 9, 10, 11, 12:
o DTPffiTap - 3 doses, last dose must be received after age 4 - if the child has received 6
doses before the fourth birthday, additional doses are contraindicated.
o Polio (all OPV or all IPV) - 3 doses of vaccine, last dose must be received after age 4 or
4 doses at any age.
o MMR - 1 dose (after 12 mos. of age) and 2nd MMR or 2nd measles (rubeola)
o Hep. B - (Hepatitis B) - 3 doses; if student has RECOMBIV AX HB - 2 doses
o Tdap - booster required if not received prior to entering 6th grade
o Varicella/Chicken
Pox - All students born on or after 1/1/97 are required to have 1 dose,
not earlier than 12 months of age.
Documentation ofTdap or Tetanus required for entry. Note: Only 1 dose ofTdap is
required even if it has been more than 5 years since the Tdap was given.
D No Physical Exam required for grades 9-12.
D Social Security Number (optional)
D Transcript from previous school(s)
D Copy of most recent report card
D Copy of IEP or Special Education Records (if applicable)
D Student Enrollment Form
D Student Demographic Form
D Emergency Care Permission Form
D Demographic/Transportation
Form
D Parent Affirmation of Suspension Form
D Consent to Exchange Information Form
D Migrant Education Form
D Federal Race/Ethnicity Form
D RCPS School Messenger Form
D Bus Rules Signature Form (remove from Student Handbook)
o Student/Parent Handbook Verification Form (remove from Student Handbook)
o Directory Information Form (remove from Student Handbook)
o Media Release Form (remove from Student Handbook)
Contact the Registrar, Debbie Correa at (540)289-3100 or (540)289-3101 to schedule an
appointment to begin the enrollment process.
,
Building
Blazer
Pride
ADMINISTRATIVE
AND SUPPORT STAFF
Administration:
Principal- Dr. Stephen R. Leaman: [email protected]
Assistant Principal- Paul De La Garza: [email protected]
(Students A-L)
Assistant Principal- Alicia Corral Clatk: [email protected]
(Students M-Z)
Activities Director - Tim Leach: [email protected]
Attendance and Report Cards - Debbie McDonald: [email protected]
Bookkeeper - Lorrie Newland: [email protected]
Cafeteria Manager - Dena Hoover: [email protected]
Counseling:
Director of Counseling - Sarah Lam: [email protected]
(Students A-G)
Counselor - Pamela Elmore: [email protected]
(Students H-O)
Counselor - Lynn Briggman: [email protected]
(Students P-Z)
Career Coach - Sarah Brown: [email protected]
Challenge Coordinator - Louise Liddle: [email protected]
Registrar - Debbie Correa: [email protected]
Secretary - Stacey Washington: [email protected]
Front Office Secretaries Secretary to Principal and AD - Wanda Hinkle: [email protected]
Julia Smith: [email protected]
Debbie Hensley: [email protected]
Librarian - Kim Tate: [email protected]
Nurse - Debbie Raines: [email protected]
Resource Officer - Matt Cross: [email protected]
SOL Testing Coordinator - Amanda Bolt-Burtner: [email protected]
Special Education Chair - Bob Lewellen: [email protected]
It is the policy of the Rockingham County School Board to comply with all applicable state and federal laws regarding
non-discrimination in employment and educational programs and services. It is an equal opportunity employer and
educational agency.
The Rockingham County School Board will not discriminate in hiring, promotion, discharge, pay, fringe
benefits, job training, classification, referral, and other aspects of employment or in educational programs and
services on the basis of race, color, national origin, religion, sex (including pregnancy), gender, marital or
economic status, age, disability, genetics, or veteran status and prohibits retaliation against anyone who files a
complaint of discrimination, participates in such a proceeding, or otherwise opposes discrimination.
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It is required that your primary residence (911 or physical address) be located
within the Spotswood High School attendance area. As proof that you are residing
here you must provide a minimum of three (3) of the following six (6) items:
1. A notarized statement - Certification of Residence form from the. owner of the
house where the person is living within the SHS attendance area, listing the
names of the person and their child(ren) and a visit by a school official.
2.Notarized rental/purchase agreement for a house within the SHS
attendance area with the person's name and address on it.
3.Recent utility bills (electric, telephone, gas, etc.) with current name
and address within the SHS attendance area.
4. Current Drivers license and automobile registration with current name and
address within the SHS attendance area.
5.Current Car insurance and property insurance policies with current name and
address within the SHS attendance area.
6.Recent Income tax W2 form and property tax bill with current name and address
within the SHS attendance area.
You may also expect a home visit from a school official to verify that you are living
in the SHS attendance area. No student will be enrolled at Spotswood until these
requirements have been met.
§ 22.1-264.1. Misdemeanor to make false statements
as to school division
or attendance
zone residency;
penalty.
Any person who knowingly makes a false statement concerning the residency of a child, as determined by § 22.1-3, in a
particular school division or school attendance zone, for the purposes of (i) avoiding the tuition charges authorized by
§ 22.1-5 or (ii) enrollment in a school outside the attendance zone in which the student resides, shall be guilty of a
Class 4 misdemeanor and shall be liable to the school division in which the child was enrolled as a result of such false
statements for tuition charges, pursuant to § 22.1-5, for the time the student was enrolled in such school division.
(2005, c. 178; 2006, c. 143.)
Building Blazer Pride
STUDENT ENROLLMENT FORM
ROCKINGHAM COUNTY PUBLIC SCHOOLS
(Please print)
Date
_
First
Name that student wishes to be called
_
Grade ----- Sex ----------
Student's Mailing Address ------------------------Phone No. --------City
_
Zip
_ Student's Cell Phone No.
---------Student's 911 Address (if different than mailing)
-----.,..,------
------,-,---_
City
Zip
Birth Cert. No.
Place of Birth ---------------------
_
Last School Attended ----------------Address of Last School Attended -------------------------~----~--~City
State
Zip
Telephone No. of Last School
Fax No. of Last School
With whom does this student reside?
Circle one: Mother/Step- Mother/Grandmother/F
_
oster/GuardianiOther
Name
~Home
Phone No.
Address (if different than child's)
_
_
Employer
Work Phone No.
Cell Phone No.
_
Email Address
_
--------------------
Circle one: Father/Step-Father/Grandfather/Foster/GuardianiOther
Name
HomePhoneNo.
Employer
Work Phone No.
Cell Phone No.
_
Email Address
_
_
----------------------
If the parent(s) listed above are not the biological parents, please complete this section:
Mother/Father:
Address:
Name --------------------------
Home Phone No. -----
--------------------------------------------
Employer
Work Phone No.
Cell Phone No.
Office Use
Birth Certificate
Email Address
Social Security _
Physical
_
Federal Race
Proof of Residence
_
PAGE 2
Number of Other Children
Younger Brothers __
Older Brothers
CUSTODY:
in the Family:
Younger Sisters __
Older Sisters
Is there a custody order on this child?
If so, who has custodial rights to pick up this child from school?
(Please provide the school with a copy of the legal document.)
What is the language spoken most frequently in the home (if other than English)?
Is there a language other than English spoken in the home?
Yes
No
_
NOTE: Ifhome language is other than English, or yes is answered, an ELL Student Identification
and sent to the Central Office.
Most Recent Two Schools Previously
If not listed above,
*High Schools:
*Middle Schools:
*Elem. Schools:
Grade(s)
Attended
_
Form MUST be completed
Guidance
please circle below any Rockingham County Public School the student has attended in the past:
Broadway, East Rockingham, Spotswood, Turner Ashby
Elkton, J. Frank Hillyard, Montevideo, Wilbur Pence
CRES, EES, FRES, JCMES, JWES, LSES, LEES, MES, MVES, OES, PKYES, PES, PYES, RBES, SRES
Has your child's school been notified of your plans to withdraw?
Yes
No
_
Has your child ever been home schooled as a result of an approved religious exemption? Yes
Myres~enceisloc~edinilie
Rockingham County.
Parent/Guardian
Was your child involved in any special programs
___
Special Education
~~
Challenge (Gifted)
___
Other - Please specify
Are immunizations complete?
_
yes
regarding
No ---
my residence is accurate.
Signature
at their previous school?
- Is there a current IEP?
---
_
Alternative Education
~
_
no (DPT, MMR, POL, HepB)
Does your child have a handicap or other special need that may affect his/her performance?
Doctor:
_
~B~r~oa~d~w~a~y~~E~a=s~t~R~o~c=~=·=ng_h=a=m~~~S~p~o~b~w~o~o~d~~~T~u=r~n~e~r~A=s=h=b~y~~at
(Circle one)
I certify that the above information
Please describe:
Counselor
_
-----------------------------------
----------------------------~---------EXTRA-CURRICULAR SPORTS - HIGH SCHOOL STUDENTS ONLY
•
•
My child participates in an after-school athletic program
If yes, which athletic program(s)?
YIN
---=-_...,...-:-~
Revised 3120J 5
Revised 7-13-10
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Required Field
~ATE
_
GR.A~E
lLASTNAME
_
MIDDLE
FffJI?S7!'NAME
Check Appropriate
Action
( ] New Address
~fiRTH~ATE
[ ] New Student
_
§EX:
[ ] Withdrawal
[] Male
NAME
[ ] Retained
[ ] Female
it'AfI.!ENT(§) OR GlU AlRlIJ)llAN(S)
_
~OMEPHONE
9 RR
_
RE§mENCE
CELL~HONE
_
A][))~IRE§§ (HOME)
House # and Street
Town and Zip Code
9R R
ALT ADDRE§S
House # and Street
Town and Zip Code
Required Field
TRANSPORT
AnON NEE~§:
AM
[ ] Residence Address
[ ] Alt Address
[ ] Not Riding
]PM
[ ] Residence Address
[ ] Alt Address
[ ] Not Riding
For School Use
FOR 'TRANSPORT
A 'JI'liON OFFICE USE ON1L 1{
Powerschool #
,
Will Ride Bus #
am time
Entered into Powerschool
I
II
"Will Ride Bus #
pm time
Faxed to Transportation
(433-2460)
I
I
I
I
ROCKINGHAM
COUNTY PUBLIC SCHOOLS
EMERGENCY CARE PERMISSION
Student
Student:
Mailing
Address:
Birthdate:
-------------------------------------------
HomeRoom:
911 Address:
Parenti
Guardian:
Guardian e-mail:
Mother
Information
Gender:
Grade:
-----------------------
Bus:
AM
_
PM
Home Phone:
-------------------------------------------
Primary
#:
Name
Employer:
Home:
Telephone:
Father
Information
Work:
Cell:
Work:
Cell:
Name
.
Employer:
Home:
Telephone:
#1 Information
IGuardian
Relationship
Name
Employer.
Telephone:
Home:
Work:
#2 Information
Guardian
Cell:
Name
Relationship
Employer:
Irelephone:
Home:
Emergency
Contact
Work:
Cell:
Information
he individuals below have authorization to pick up my child and can be reached during school hours at the numbers listed.
Name:
Re:
Phone:
Name:
Re:
Phone:
Name:
Re:
Phone:
Cell:
-------------------------
Cell:
Cell:
-------------------------
In an emergency, the school has permission to call our family doctor or dentist below
Physician's
Dentist's
Phone:
Name:
Name:
Phone:
If an emergency OCCUflI and we cannot be contacted. the school has our permission to take the child to the doctor or hospital at our expense.
The doctor and/ or hospital medical staff have my permission to provide the treatment necessary for the well-being of our child.
The RockinghamCountyPublicSchooldivisionis committedto protectingtheprivacy,security.andintegrityof individuallyidentifiableinformationreceived
fromyou,on behalfof yourchild.We mayuseyourinformationto providetreatmentto yourchildor to discloseinformationto otherhealthcareproviders
as indicatedon thisform.The schooldivisionis preparedto maintaincompliancewiththe HealthInsurancePortabilityandAccountabilityAct(HlPAA)andother
regulatoryrequirementsbyadoptingandadjustingpoliciesandprocessesas necessary.
1. His/her last Tetanus shot was given about
2. Is your child allergic to any medicine, food, or other substance?
List allergies:
3.
Does your child have the following
o
D diabetes
asthma
List medication
condition(s)
D seizures
as diagnosed
--- -
-
0 Yes
-- ---
-.
-
-
---
_
..
--------
o No
by a physician?
D allergy
to insect bites
needed:
4.
Prescription
medication
5.
Other medical conditions
Parenti Guardian
For School Use Only
__ Emergency Alert Form
your child takes on a regular basis:
the school should know about:
Signature'
Date'
o School/Private
o Medicaid
D-FAMI5--
Insurance
.-
ROCKINGHAM COUNTY PUBLIC SCHOOLS
Parental Affirmation
Regarding Previous Student
Suspension/Expulsion
Virginia law requires that, prior to admission to any public school of the Commonwealth,
a School Board shall require the parents, guardian, or other person having control or
charge of a child of school age to provide, upon registration,
a sworn statement of
affirmation
indicating whether out-of-school
disciplinary
measures have been imposed
upon the student at a private school or in a public school division in the Commonwealth
or in another state for an offense in violation of school or School 130:u-d policies relating
to weapons, alcohol or drugs, or for the willful infliction of injury to another person or for
destruction
of school property or privately-owned
property while located on school
property.
Any person making a materially
false statement or affirmation
that will be
guilty upon conviction
of a Class 3 misdemeanor.
The registration
document shall be
maintained IlS a part of the student's scholastic record. (Virginia Code Section 22.1.3.2)
l'l.EASE
C()l\tPI.ETE
AND SIGN
'nu: STATEMENT
1, the" \lI\drr~.igliC'11. truthtully
BEl.OW
declare lInt! ;\f1If1li that
=.~.
h;hl\l;\:i not (drdc
OIlC) Ic('dvC'd oul'l)f.:;dHllJ\ suspcl\:ii()1\ (1';)1:~I\Ykllgth 01 time) :ll\ti/Of
c,puhilJlI
illll private ~ll.:ho()1or pllb\i~ ,1dll)()1 ill Vil~iiii;ll.H·
nuothcr ~I;\lc; IllI all ()Ifen:;c ill
vio\;lIiol\ of school Ot' SdH)()1 Jh>atd policies I('titing 11.1wcnpl.HiS, ulcoltol ()/' dlll!!.'i, or for
the willful infliction
or injury
_'d'
__
'
._____.~
•
-e
her person or for destruction of school property or
privatc\Y-l)wl1cd
property while located UII 5(11001 propelty. I \11\(kl~;ti\J1d Ih!!I, 1'1)1'
PIIJllIJ:;C; of thh uffinnation.
"willful infliction of injury tl} another" 111(,<111:.; a maliciou:
Jll-;::;nlllt with the intent to cuusc serious bodily injury.
II)
allot
I undcr stuud that if I mukc u materially
Iulsc allirmation I shall be guilty upon conviction
of a Cla33 3 misdcmcunor. I am aware that this aflirmation will be maintained as a part of
my student's scholastic record.
Parent,
Date
guardian,
or person having control of child
.,
~~,
RO(~KiNG'HA'~rC'0
PJ,lJ)Ll£;S(.fjQQt5
New federal race and ethnicity categories
Student Name
_ Homeroom:
-----------------------
Address
_
School attending -------------------
Date of birth -----
Student number-----------------
Please answer both part 1 and part 2 by checking the boxes
that best describe your son or daughter.
Part 1 ;" What is the student's ethnicity? (choose only one)
D
No, not Hispanic/Latino
D
Yes, Hispanic/Latino (a person of Cuban, Mexican, Puerto Rican, South American, Central American or
other Spanish culture or origin, regardless of race)
No matter what you selected in part 1, please continue to
answer by marking one or more boxes in part 2 to indicate
what you consider your student's (or your) race to be.
Part 2'
What is the student's race? (choose one or more)
D
American Indian or Alaska Native (a person having origins in any of the original peoples of North
America and South America, including Central America, AND who maintains tribal affiliation or
community attachment)
D
Asian (a person having origins in any of the original peoples of the Far East, Southeast Asia or the
Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan,
the Philippine Islands, Thailand and Vietnam)
D
Black or African-American (a person having origins in any of the black racial groups of Africa)
D
Native Hawaiian or Other Pacific Islander (a person having origins in any of the original peoples of
Hawaii, Guam, Samoa or other Pacific Islands)
D
White (a person having origins in any of the original peoples of Europe, the Middle East or North Africa)
Parent or guard ian signature
_ Date
It is the policy of the Rockingham County School Board to comply with all applicable state and federal laws regarding non-discrimination
in employment and educational programs and services, The Rockingham County Public Schools will not aiscnminete on the basis of
race, religion, gender, national origin, disability, economic status, or age as to emptoymentsx educationalprograms and activities,
FOR SCHOOL
USE ONLY
I am the observer who completed this form due to parent/guardian refusal to re-identify.
I
Sianature.Observer
I
Date
CUUNTY PUBLIC SCHOOLS
RECORDS ANDIOR PROTECTED HEALTH
KUl,;I'\Ii'JuHAM
CONSENT TO RELEASEIRECEIVE
INFORMATION
DOB: __
Student:
Social Security
Number:
1__
1__
- ----
--
I understand that different agencies provide different services and benefits. Each agency must have specific information in order to
provide services and benefits. By signing this form, I am allowing the Rockingham County Public School system and the identified
agencies to exchange authorized information to effectively provide or coordinate services or benefits.
By signing
this authorization,
I am giving my permission
to have the following
confidential
o
•
information
about my child to be exchanged:
Assessment
Information
Medical Diagnosis
• Educational Records
Information
Criminal Justice Records
Psychological Records
Employment Records
Social History
SpeechlLanguage
Reports
• Immunization Records
III Official Administrative Record (name, address, parent's name and address, SSN, grade level completed, academic
record, class standing, attendance data, extra curricular activities, citizenship)
o Financial
o
o
o
o
o
Drug and alcohol abuse diagnoses or treatment information is exempt from this release and protected by Federal substance abuse confidentiality rules
(42 CFR part 2). A student's disciplinary file is not protected information and may be released without consent to other school districts within the State
of Virginia or to law enforcement agencies.
I hereby authorize
o
(please check appropriate
location):
Director, Pupil Personnel Services
ROCkingham County Public Schools
100 Mount Clinton Pike
Harrisonburg, VA 22802
o
(School Name)
bR. STEPHEN R. LE1i1Yl
AN
(Principal)
(Address)
Pf)JN LAfRb vA
( S4D )
31DI
rn -
To be able to exchange
I
this information
zz~4le
(Phone)
(Address)
(SZ/D ) z~tt
-
with the following other agency(ies}:
3301
(Fax)
(Please include address)
Are more agencies listed on back?
For the purpose
of:
o Eligibility Determination
o IEP (review, revision, andlor implementation)
o Service Coordination and Treatment Planning
o Educational Planning
o Other (be specific):
Unless otherwise revoked, this authorization
expire one year from the date signed.
(school/grade
will expire on __
placement,
1__
YES
0
NO
0
(mental health)
course selection, etc.)
1__
. If there is no date entered, the authorization will
I can withdraw this consent at any time by notifying the referring agency. This will stop the listed agencies from sharing information after they know my
consent has been withdrawn. I have the right to know what information about me has been Shared, and why, when, and with whom it was shared. If I
ask, each agency will show me this information. I want all the agencies to accept a copy of this form as a valid consent to share information. If I do
not sign this form, information will net be shared and I will have to contact each agency individually to give them infermation about me that they need.
I understand that an agency may condition eligibility for benefits or services en previding this information. There is a potential fer any information
disclosed pursuant to.this authorization to.be subject to redisclosure by the recipient and, therefore, no.lonqer protected by the provisions of the IDEA,
FERPA, or HIPAA regulations.
Date: __
Signature:
Signature of ParentlGuardian/Surrogate/Adult
or Authorized Representative
Relationship
to student:
' __
1__
Student
_
Revised: 4110106
Revised 81201 I
Rockingham County Public Schools
ELL Student Identification Form and Home Language Survey
This form is to be completed for all students newly enrolled in Rockingham County Public Schools who are English
Language Learners (ELL) and/or were born outside the United States. Forms should also be updated at the
beginning of each school year for each ELL student in the school division. Keep a copy in the student's Scholastic
Records file, and send the original to the ELL secretary in the Central Office.
Directions:
Student's LAST name, FIRST name
Sex
Today's date
Date of birth
_
_
School
_
Grade
-------------------
_
Parents/Guardians
_
EngliSh-speaking family member or contact person
_
Country where student was born
_ Date student first moved to U.S.A.
_
Date Student first entered VA'School
Student's native language
_
_
Number of years of school in home country
Is student literate in his/her native language?
(Y yes N no U unable to determine)
=
=
=
Language spoken most frequently in the home
FOR OFFICE USE ONL Y
_
Does the family have refugee status, 1-94?
_
Other language(s) spoken in the home
_
FOR OFFICE USE ONL Y
W-APT
PALS
QRI-IV
Fall
Mid-Year
(Circle One)
Spring
STAR
Year Administered
Student Score
Grade Level Cluster
IRI
D
Grade-Level
benchmark
D
Running
Record
Other
Lexile™
(Circle One)
Instructional
most recent
date administered
Reading Level
D
(most recent date administered)
Stanford Diagnostic ReadintJ
(most recent date administered)
Composite
(Overall)
Proficiency
ACCESS for ELLs
(most recent date administered)
ELL Status
Fill in the appropriate number or letter,
using the keys below.
Level
FOR OFFICE USE ONL Y
Pre K - 3
Grade Adjusted CPL {Composite
Proficiency Score)
D
_
_
PK
1 Entering
=
Score
D
Literacy
Proficiency
Score
D
ACCESS
Tier
D
D
Pre-kindergarten
Level 2 Beginning
N
= No ELL assistance
Level 3 Developing
R
= Refused
needed. English is the student's second
language; however, student was not found in need of ELL services.
*Note:
ACCESS for ELLs score or W-APT score needed
Level 4 Expanding
Level 5 Bridging
First Year
Person completing this form
ELL TeacherlTutor_-,--Send the original completed form to the ELL secretary, Central Office.
Keep a copy on file in the student's Scholastic Record.
_
Rcvd
Source
_
yes __
Shenandoah
no
Valley Migrant Education Program
JMU MSC 9007
Harrisonburg, VA 22807
Phone: 540.5683666
Fax: 540.568.6374
wwwsvrnep.jrnu.edu
ELIGIBILITY QUESTIONNAIRE
1. In the last 3 years, have you or your spouse worked in (or looked for work in) any of these jobs:
***( Please note if you have done any of the following work whether or not it was in Virginia)
• Poultry processing plant line work (Tyson, Cargill, Perdue, Pilgrim's Pride, Georges);
• Growing or harvesting a crop of fruit, vegetables, or trees;
• Work on a dairy or poultry farm or in the fishing industry;
• Or caring for animals on a farm or ranch?
Yes
No
If the answer to number 1 is "yes", Please complete the rest of this form:
2. When did you move to the
area?
month ------
year
_
3. Name(s) of Child(ren) enrolling in school today:
Name
--------------------------
Age
Name
--------------------------
Age
_ Grade -----_ Grade
Age
_ Grade -----
Name
-----------------------4. Parent/Guardian information (if student is a minor):
Name
. Address
Telephone number
-----------------------------------------
City ____________________
Zip code
5. School Child(ren) will be attending:
6. Please fax this form to the SVMEP office at 540.568.6374
Name of intake person
_
**Based on the information provided a representative from the Shenandoah Valley Migrant Education Program will contact you about the
services offered by the Migrant Education Program.
Migrant Education is a NCLB Title One, Part C program that provides supplemental educational services to children of miqrant
agricultural workers, people who have moved to this area (or have moved frequently) to find agricultural work. We specialize in
addressing the needs of second language learners who have had interrupted educational histories.
~
e
ROCK(NGHAMC0
PUBLIC SCHOOLS
SCHOOLMESSENGER
t~~
~
To the Parent of: ----------------------Grade: -----Rockingham County Public Schools are implementing a new emergency and inclement
weather notification system. As part of this effort, we are in the process of updating the
phone numbers and e-mail addresses at which you may be contacted.
,
The following list contains phone numbers and e-mail addresses we currently have on file
for you student. Please review this information and modify it as needed. You will also be
able to manage this information in the PowerSchool parent portal.
Thank you!
Telephone: Please indicate the phone numbers at which you want to receive recorded
phone messages. Cross out any existing numbers if you do not wart to receive calls at
those numbers.
Main Phone Number:
(Used for attendance calls)
Additional Phone #2:
Additional Phone #3:
_
SMS: Please indicate the phone numbers at which you want to receive text
messages. Cross out any existing numbers if you do not want to receive text
messages at those numbers.
SMS Phone #1:
SMS Phone #2:
SMS Phone #3:
E-mail: Please indicate the e-mail addresses at which you want to receive notification
messages. Cross out any existing e-mail addresses if you do not want to receive e-mail
messages.
E-mail Address #1:
E-mail Address #2:
E-mail Address #3:
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