Southeast Student Information Form

Form

Southeast Student Information Form - Information is shared with Southeast Staff and Karns Adopt a Family Program - if you have any concerns with sharing please notify the school office
Today's Date

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Birthdate*

MonthDayYear
Date
T-shirt preferred size*
Polo preferred size and fabric*
Children - Names and birthdates
Anniversary if married
Where are you from?
Food allergy or dietary restrictions (Vegetarian, Vegan, Low Carb, Gluten-free, Keto, etc)*
Favorite candy bar or salty snack*
Favorite food or type of food
Food you do not like
Anything else you would like to share
Emergency Contact Name*

First NameLast Name
Emergency Contact Relationship to you*
Emergency Contact Mobile Phone Number*

Area CodePhone Number
Emergency Contact Email*
example@example.com
Should be Empty: