Secondary Parent or Guardian Communication Information Sheet

(if needed)

Youth/Child’s Name ______________________________________

Your Name(s) _________________________________________________

Mailing Address _______________________________________________

City, State, Zip (if not in Port Clinton) ________________________________________

Landline phone number __________________________

Is there an answering machine? _____ Yes _____No

E-mail information

Parents Home E-mail address____________________________________

Are you allowed personal e-mails at work? _____ Yes _____ No

Mothers Work E-mail address___________________________________

Fathers Work E-mail address____________________________________

Cell phone information

Mothers Cell phone number _______________________________

Fathers Cell phone number ________________________________

Work information

Can you accept personal calls at work? _____ Yes _____ No

Mothers Work & phone number __________________ _________________________

Fathers Work & phone number ___________________ _________________________

What is your best means of communication?

_____Cell phone Whom do I contact? Mom Dad (circle one, the other, or both)

_____Texting

_____Landline

_____E-mail Whose do I write to? Mom Dad (circle one, the other, or both)