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STUDENT INFORMATION REQUEST FORM 2001-2002

THIS FORM MUST BE FILLED OUT BY PARENT NOT STUDENT

STOP LOCATION:________________________________________ _____________

NAME:____________________________________________ _________________

HOME ADDRESS:_________________________________________ ____________

CITY_____________________STATE:SOUTH CAROLINA ZIP CODE_________

AGE_______________________PHONE #_________________________________

PARENTS NAMES

MOTHER___________________________________________ _________

FATHER___________________________________________ _________

SCHOOL ATTENDING :________________________________________________ ____

GRADE____________________________________________ _____

E-mail Address:_________________________@_______________ _________

Mothers Work Phone #__________________________________

Fathers Work Phone #__________________________________

PARENT SIGNATURE__________________________________DATE__ __________




Please Keep the bottom for your records

Bus Driver: Mr. Tony Darmanin

Home Phone: (803) 892-4572

Cell Phone: (803) 447-4273

E-mail: bus13@usa.com