Student/Parent Contact Information

Collins Career Technical Center

11627 State Route 243

Chesapeake, OH 45619

hs@collins-cc.edu

highschool.collins-cc.edu

(740) 867-6641
Parent Contact INformation
School Year*

Student Information
Student Full Name

First NameMiddle NameLast Name
Year Level
Home School
CCTC Career Program
Student Birth Date*

MonthDayYear
Your Relationship with the Student

I am the studentI am a parent (with full or joint custody)I am a parent (without full or joint custody)I am a legal guardianOther
Student Residential Address

Street Address

Street Address Line 2

CityState

Zip Code

Additional Information
Please provide any additional information regarding parent contact or child custody information.

Form Completion
Please complete additional forms for each person you want to be added to the student's contact information. A link to complete another form will be presented once you submit this form.

If you complete this form. You may ignore the parent contact information form in the packets that students bring home
Name of Person Completing this Form

First NameLast Name
Signature

Clear
Please verify that you are human*
Should be Empty: