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Your Name

Students Name

Relationship to student

Please provide the phone number best to reach you.

Can you receive texts at the number provided?

yes

no

Please provide an active email address we can use to contact you.

how do you prefer to be contacted?

TEXT

PHONE

EMAIL

ANY

What internet accessible technology do you have accessible for the student to use in the home?

If you have no internet access in the home what plan do you have in place to allow your child to access the internet to complete assignments?

Are there any concerns regarding your child you would like to share with the 5th grade teaching team?