Northgate School Directory 2011-2012

Please enter the information you wish published in the school directory. Student's name and grade level are required fields. Please check spelling! EACH student requires a SEPARATE form.

Grade Level

Student FIRST Name

Student LAST Name:

Student's Home Address & Phone Number #1

Street Address #1:

City #1

Area Code

Home Phone No.

-

Parent/Guardian Names as they will appear in directory

(use first names only unless there is a different last name)

E-mail Address:

Student's Home Address & Phone Number #2 (if applicable)

Street Address #2:

City #2

Area Code

Home Phone No.

-

Parent/Guardian Name as it will appear in directory

(use first name only unless there is a different last name)

E-mail Address (only ONE address per household):

Authorization

Directory Authorization

I authorize Northgate PFC to publish the above information for the student directory. The directory is published as a service for the members of the Northgate PFC only.

Parent Action Team Pledge

I/we agree to be present during student gatherings in my/our home, to prevent the use of alcohol or drugs in my/our home and to be receptive to and encourage calls from other parents about details of student activities in my/our home.

Please contact Gloria Bertolozzi if you have any questions about the directory.

Indicates Response Required