CEDAR BROOK ACADEMY
- DATA INFORMATION SHEET -

Parent's Last Name   Parent's First Name     & 
Street    Home Phone  ()   -    (Area code & number)
City    County     State     Zip   
Cell Phone / Emergency Phone   (this information will not be in the directory)
Do you wish to be included in the CBA Telephone Directory (form must be returned by August 1st)?    Yes  No
Would you like your E-mail address printed in the directory?    Yes  No
E-mail Address  
Would you like to receive the newsletter and other information by e-mail?    Yes  No
Curriculum (in a few words, what materials or texts do you primarily use)?   


** Fill out this part of the form completely for each student enrolled in CBA
for the school year   - **
    (ex 2007 - 2008)
1.  Student's Last Name    First Name   MI
    Name Goes By     DOB    Sex    Grade 
2.  Student's Last Name    First Name MI
    Name Goes By    DOB    Sex    Grade 
3.  Student's Last Name    First Name MI
    Name Goes By    DOB    Sex    Grade 
4.  Student's Last Name    First Name MI
    Name Goes By    DOB    Sex    Grade 
5.  Student's Last Name    First Name MI
    Name Goes By    DOB    Sex    Grade 

Use the Following Area to Record Any Additional Students, Names of Students Transferring Out of the Academy, Etc.




 

 

Copyright © Cedar Brook Academy 2008
  23700 Stringtown Road
  Clarksburg, MD 20871		 Phone: 301-528-6706
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