Miss Kuebler's Student Information Log-Form

Welcome to the 2007-2008 School Year! To make sure we get off to the right start I need some personal information from you. Help me out by filling in the blanks with your information!

Basic Information

First Name:

Middle Initial:

(Do not include a period)

Last Name:

Age:

Gender:

Birthday:

(mm/dd/yyyy)

Siblings:

Address and Phone Numbers

Home Address:

(Street Only)

City:

Zip Code:

Phone Number:

(1EExample: (973) 321-0020 456-7890

Cell Number:

(12Example: (973) 321-0020 890

Parent's Information

Mom's Name::

Mom's Job Title:

Mom's Cell Number::

Example: (973) 321-0020

Mom's Work Number:

Example: (973) 321-0020

Does your mother live with you?

YesNo

Dad's Name:

Dad's Job Title:

Dad 's Cell Number:

Example: (973) 321-0020

Dad's Work Number:

Example: (973) 321-0020

Does your father live with you ?

Yes No

FaFavorites

Favorite Subject:

Favorite Sport:

Check the Boxes that Describe You:
*Check all that apply

Funny Late

Smart Lazy

Determined Sloppy

Hard-Working Unorganized

Neat Distracted

Favorite Color::
*Choose One

Red Blue Orange Yellow

Black Green Pink Brown

Tell Me More About Yourself:
Is there anything else I need to know?