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Blue Sheet Survey

WELCOME!

Dear Parents/Guardians:

Welcome to Middle School of Media, Law & Fine Arts!

Please fill out this mandatory survey in order to communicate essential information to Middle School of Media, Law & Fine Arts, especially Accepted Student Orientation and Freshman Orientation. As a reminder, you will need the following information:

     • Student Biographical Data: 
          Name, Home Address, Email, Home Phone, Cell Phone, Student ID/OSIS number (Public school students can get this from their guidance counselor. Private school students, use 888888888), Date of Birth, Gender, and Ethnicity.

• Emergency Contact Information (Blue Card Information): 
          In the event of an emergency where we cannot reach the parent/guardian of record, choose three people who can get to Middle School of Media, Law & Fine Arts to pick up a sick/injured student. All contact information is required for each of the people selected.

Emergency Contact

Student's Gender*
Answer Required

1st Parent/Guardian - Contact Information

 

 

Parent's Preferred Language of Communication

Address
State
Answer Required

Other Parent/Guardian

Preferred Language of Communication

Address
State
Answer Required

List below names if two (2) persons who may be called in case of emergency or if child is sick in school

If there is a person who may NOT HAVE ACCESS to child, please indicate:

Order of Protection Exists
Answer Required

Health Information

Health Alert

Does child have any health condition that may affect participation in physical activities?*
Answer Required
504 Services for the current year*
Answer Required
My child has:*
Answer Required
If " No Health Insurance", are you willing to share contact information from this card to learn about insurance options?
Answer Required

Siblings

LEGAL AFFIRMATION