Your First Name

Your Last Name

Relationship to Student: Mother Father Grandmother Grandfather Aunt Uncle Older brother Older sister Guardian

Student's Name:

Student's Biotechnology Class Period: 7th grade 1st Elective Period 7th grade 2nd Elective Period 8th grade 1st Elective Period 8th grade 2nd Elective Period 6th grade 1st Elective Period 6th grade 2nd Elective Period

Email address:

Day phone number:

Evening phone number:

Preferred time to call:

Does your daughter or son have Internet access at home?   True   False

If you have Internet access at home, what type of Internet connection o you have? High speed (DSL, Cable or satellite) Low speed (dial-up)

Would you like to volunteer in any of my classes?   True   False

Please describe any knowledge/skill you might like to share with our students.

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