CEDAR BROOK ACADEMY
- DATA INFORMATION SHEET -

FILL THIS FORM OUT COMPLETELY AND RETURN BY AUGUST 1ST
Parent's Last Name   Parent's First Name     & 
Street    Home Phone  ()   -    (Area code & number)
City    County     State     Zip   
Include information in the CBA Telephone Directory?    Yes  No (must respond before August 1st)
Include e-mail address in the directory?    Yes  No (must respond before August 1st)
E-mail Address  
Dad's Cell Phone  (this information will not be in the directory)
Mom's Cell Phone  (this information will not be in the directory)
Church Affiliation 


** 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.