7th Grade PE – Mr. Dee

STUDENT NAME: ____________________________________________

PE PERIOD: _________

DO YOU HAVE INTERNET ACCESS AT HOME? YES ______ NO _____

STUDENT LIVES WITH (CHECK ANY THAT APPLY):

MOTHER ______ FATHER ______ OTHER ______

MOTHER/GUARDIAN NAME: ____________________________________________

SIGNATURE: ___________________________________________________________

I have read and understand the class introduction for Mr. Dee’s PE class

HOME PHONE: _____________________ WORK PHONE: _______________________

CELL PHONE: _____________________ E-MAIL: ______________________________

FATHER/GUARDIAN NAME: ____________________________________________

SIGNATURE: ___________________________________________________________

I have read and understand the class introduction for Mr. Dee’s PE class

HOME PHONE: _____________________ WORK PHONE: _______________________

CELL PHONE: _____________________ E-MAIL: ______________________________

This form is due Tuesday August 23^rd (A Day) & Wednesday August 24^th (B Day)