Lewis Elementary
Please fill out this confidential form online that will be sent directly back to me. If you have additional questions or comments, please E-mail me at allison.gurski@cobbk12.org
Student Information
Teacher's Name Select Teacher Mrs. Gurski School attended last year? Lewis Other Cobb Cty. School Outside Cobb Cty. Outside Georgia
Student's Last Name
Student's First Name
Birth Date
Mother's Full Name
Father's Full Name
Street Address
City, State
Zip Code
Email address
Home Phone
Cell
Work
Emergency Contact
Emergency Contact Number
Does your child have allergies? Please list if checked:
Is your child on medication? none home school Please list medications:
If your student has a sibling, please include name, grade, and teacher of each sibling.
On a weekly basis, what transportation does your child use in the afternoons? Bus Car/Day Care ASP Alternates Bus Number: You must enter a bus # to complete this form.
Are you interested in being: Room Parent
Copy, laminate, cut-out, small project Parent Media Center Volunteer Field Day Volunteer Field Trip Chaperone
Thank you for your time! Sincerely,
Mrs. Gurski