Student Contact Information Sheet
2009-2010

Please complete and submit the following form.  Please resubmit whenever there is a change in your contact information.

All information will remain confidential.

Students entering competitions and festivals MUST have a proof-of-age document (passport, birth certificate, driver's license, CA I.D.) on file.
Please bring a copy OR scan and e-mail to me as a .pdf or .jpeg

PLEASE USE THE TAB KEY TO SCROLL FROM FIELD TO FIELD.

Student First Name

Student Middle Name(s) Optional

Student Last Name

Street Address (please include Apt. #)

City

Zip Code

Home Phone (please include area code)

Cell Phone (please include area code)

Alternate Phone (please include area code)
(for example: mom's work &/or cell; dad's work &/cell; nanny's cell phone)

Student e-mail(s)

Parent e-mail(s)

Student Birth Date (mm/dd/yyyy)

Student Grade in School (2009-2010)

Name of Current School and City
(for example: New Roads High School, Santa Monica)

Food Allergies/Dietary Restrictions

Have you previously submitted a Proof-of-Age document?
yes
no