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Student/Parent Questionnaire

Dear Parents/Guardians,
        The first day of school is almost upon us! To gain a little more knowledge about your child, I have created this questionnaire sheet for you to complete together.
        Thank you in advance for all of the support this upcoming school year. Please feel free to contact me by writing a note in your child’s communication notebook or calling me directly at the junior high or by emailing me –

 Student/Parent Questionnaire:
Student Name: _______________________________________________
Birthdate: ___________________________________________________
Address: ____________________________________________________
Phone Number: _______________________________________
Parent/Guardian Names: _____________________________________
Siblings: _________________________________________________
          Color: __________________________
        Animal: _________________________
        Activity: ___________________________
        Food: ___________________________
        Class subject: _______________________
Least Favorite:
        Color: __________________________
        Animal: _________________________
        Activity: ___________________________
        Food: ___________________________
        Class subject: _______________________
Medical Info:
Allergies: _______________________________________________ 
Current Medications and for what purpose: ____________________________________________________________
Does your child have Medicaid services and if so, who is their Medicaid Service Coordinator: _________________
Are you currently affiliated with any agencies (ex. Arise, Parents of Special Children, OCO) and if so, who is your contact: ________________________________
Any Additional Information ___________________________________________________________________________
 (Can include anything special about your child, other things they may like or dislike, or strategies that work for them):





Brian Pulvino, Superintendent
129 Curtis Street
Fulton, New York 13069
Phone: (315) 593-5500

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