CHS Parent Commitment to Excellence Survey

Please fill in as many fields as possible. If you see an asterik (*), the field is required.

HINT: Use the TAB key to get to the next field (or just click in a field)

1. You are the parent or LEGAL guardian of (check all that apply):

You are the parent or LEGAL guardian of (check all that apply): AARON T ADAMS E AKERT R ALLEN C ALLEN L ALLEN-COOPER K ALLEN-SMITH D AUSTIN C BALL E BARNES T BATCHELOR D BATCHELOR K BELL T BERKLEY J BEZOLD C BEZOLD E BLAHA N BODANSKE J BOYNTON A BOYNTON W BRADY B BRISBY S BROWN JA. BROWN JO. BROWN K BROWN W BURG J BURNS S CABRAL A CAMPBELL A CANTORAL C CARRAO A CARTAGENA A CARTER D CARTER T CASEBEER D CHA B CHA C CHA L CHA V CLARK T CLAYTON D CLAYTON J COLLIER Q COLSON D CONN A CORPRUE L COVINGTON T CRUZ A CUMBY K DAVIS JAK. DAVIS JAN. DAVIS M DAVIS Z DICKERSON S DIXON J DONELSON M DUNN E EATON S EILAND T EVANS F EVINS E FALCK K FALCK T FEARS M FERNANDEZ G FEWELL S FISHER D FISHER L FLOWERS J FRANKLIN H FRANKLIN I FREEMAN K FREY D GAMM C GAMM S GARCIA J GENSLER B GILES P GILPIN Y GODLEY I GONZALEZ E GOVANI A GRANBERRY B GRANT D GREEN C GUTHRIE D GUZMAN C HANEY F HANSEN N HARRIS B HARRIS J HARRIS N HARRISON T HAUBOLDT M HAWKINS R	HAYNES I HEBRON A HEIDEMAN R HENDERSON J HER B HER K HER P HERGN CHA. HERGN CHR. HERR B HILEY A HILL A HILLMAN T HOGANS S HOLLOWAY S HOUSE D HOWELL J HUGHES J HUGHLETT M HULL J HURT K HUSSEIN B HUTCHINS C JACKSON D JACKSON K JACKSON L JACKSON S JINES T JOHNSON D JOHNSON E JOHNSON J JOHNSON L JOHNSON S JOHNSON-HUFFMAN S JONES D JONES S JUMA R KAFKA D KAFKA E KEMP F KIDD D KILLORAN T KING L KING T KRISTBAUM D KUYKENDOLL C LAMAR D LARK S LARKIN C LASSA A LECHER R LEE Q LEE S LEE T LEWIS D LEYVA J LIMMITT K LISTON M LO J LOCKETT K LOR K LOR L LUCIO M MACK D MANISCALCO R MARTIN DA. MARTIN DE. MAYO A MCADOO K MCADORY R MCCLELLAN F MCCOY J MCGUIRE L MENDOZA M MILLS O MOBBS C MOORE A MOORE D MOREHEAD D MORRIS T MOSES S NELSON-MAXWELL J NEUMAN A NICHOLS A NICHOLS D NICHOLS M NUNNERY HARDEN D OLIVE Y OUTLAW P PATES T PATNODE C PATRICK C PATTERSON S PETERSON D PFISTER D PFISTER F	PHILLIPS J PHILLIPS T PIKALEK A POLLARD C PRINTZ J RAY S RHODE A RICHMOND D ROBERSON A RODRIGUEZ Y ROEMING C ROMANTINI M ROSS O RUBIO M SALAD I SANDERS D SANDERS M SARGEANT K SARGENT S SATCHER T SATTERFIELD R SCHARMACH V SCOTT L SENTER B SEYBOLD P SHARP K SHERIFF E SLOAN B SMALLEY D SMITH S SOLOMON T STALLINGS W STATEN D STATEN L STATEN T STEINMETZ J STEPHENS T STEWARD P STONE C STONE E STONE S SWOPES D TEAGUE M TENPENNY J THAO L THOMAS J THOMPSON D THORNTON K TILLMON J TODD K TOLBERT T TORRES E TOUSEY A TRAMMELL A TRIBLETT S TRIGGS C TURNAGE G TYLER A VANG K VANG M WATKINS H WEARY R WELLS R WEST D WHITE Q WILKERSON A WILKERSON K WILKINS P WILLIAMS AL. WILLIAMS AN. WILLIAMS D WILLIAMS EL. WILLIAMS ER. WILLIAMS K WILSON DA. WILSON DE. WILSON K WILSON T WOODS A WOODS D WRIGHT C XIONG LA. XIONG LU. XIONG Z YANG B YANG G YANG J YANG K YANG M YANG N YANG P YAX C YAX T YOUNG D YOUNG T ZAGORSKI J
Other (please specify)

2. optional: if your child's name is not above, please add here:

optional: if your child's name is not above, please add here:

*
3. Student lives with:

Student lives with:

4. If you chose "other" for the previous question please specify your relationship to the student.

If you chose "other" for the previous question please specify your relationship to the student.

*
5. Your name is:

Your name is: FIRST
LAST
FIRST (optional)
LAST (optional)

*
6. Who is taking this survey?

Who is taking this survey?

7. If you chose "other" for the previous question please specify your relationship to the student.

If you chose "other" for the previous question please specify your relationship to the student.

*
8. Mailing Address

Mailing Address Street Address
City
Zip

*
9. Phone and email

Phone and email Best phone to reach you (with voicemail)
Work phone
Other phone
Email address
Email address 2 (optional)

10. Are there any allergies or medical needs we should be made aware of?
(If yes, please explain as specifically as possible)

Are there any allergies or medical needs we should be made aware of? (If yes, please explain as specifically as possible)

11. Is there a specific doctor you would like us to contact if necessary? Name? Phone? (if you do not have the information, please call the school at a later time)

Is there a specific doctor you would like us to contact if necessary? Name? Phone? (if you do not have the information, please call the school at a later time)

*
12. Emergency Contact Info:

Emergency Contact Info: Emergency contact 1 FULL NAME
Emergency contact 1 phone (list as many as needed)

*
13. Emergency contact 1 relation to student

Emergency contact 1 relation to student

Other (please specify)

*
14. Emergency Contact Info:

Emergency Contact Info: Emergency contact 2 FULL NAME
Emergency contact 2 phone (list as many as needed)

*
15. Emergency contact 2 relation to student

Emergency contact 2 relation to student

Other (please specify)

CHS Parent Commitment to ExcellenceExit this survey

1. You are the parent or LEGAL guardian of (check all that apply):

2. optional: if your child's name is not above, please add here:

*3. Student lives with:

4. If you chose "other" for the previous question please specify your relationship to the student.

*5. Your name is:

*6. Who is taking this survey?

7. If you chose "other" for the previous question please specify your relationship to the student.

*8. Mailing Address

*9. Phone and email

10. Are there any allergies or medical needs we should be made aware of?(If yes, please explain as specifically as possible)

11. Is there a specific doctor you would like us to contact if necessary? Name? Phone? (if you do not have the information, please call the school at a later time)

*12. Emergency Contact Info:

*13. Emergency contact 1 relation to student

*14. Emergency Contact Info:

*15. Emergency contact 2 relation to student

CHS Parent Commitment to Excellence
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