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Misaskim school Form

All information will be kept strictly confidential. No one will have access to the information you enter on this page aside for the few necessary Misaskim volunteers.

school Information
Name of school *
Address of Main Building *
City *
State *
Zip *
Phone *
Fax
Email *
If You Have Satellite Locations Please List
Address
City
State
Zip
Phone
Fax
Email
If you have an additional school location click here.
 
Administrator/Executive Director
Please enter the primary person of contact for emergency notification below
Name *
Home Address *
City *
State *
Zip *
Home Phone *
Cell Phone *
Email *
Emergency Contact Info

IF ADMINISTRATOR IS OUT OF TOWN OR UNABLE TO BE CONTACTED, WHO SHOULD BE THE NEXT CONTACT PERSON
Name *
Home Address *
City *
State *
Zip *
Home Phone *
Cell Phone *
Email*
Emergency Contact Info
 
Yiddish/Hebrew Principal
Name
Home Address
City
State
Zip
Home Phone
Cell Phone
Email
Emergency Contact Info
Do you want this person added to the notification system?    Yes   No
 
Yiddish/Hebrew Assistant Principal
Name
Home Address
City
State
Zip
Home Phone
Cell Phone
Email
Emergency Contact Info
Do you want this person added to the notification system?    Yes   No
 
English Principal
Name
Home Address
City
State
Zip
Home Phone
Cell Phone
Email
Emergency Contact Info
Do you want this person added to the notification system?    Yes   No
 
English Assistant Principal
Name
Home Address
City
State
Zip
Home Phone
Cell Phone
Email
Emergency Contact Info
Do you want this person added to the notification system?    Yes   No
 
school Secretary
Name
Home Address
City
State
Zip
Home Phone
Cell Phone
Email
Emergency Contact Info
Do you want this person added to the notification system?    Yes   No
 
Custodian/Building Manager
Name
Home Address
City
State
Zip
Home Phone
Cell Phone
Email
Emergency Contact Info
Do you want this person added to the notification system?    Yes   No
 
Secondary Custodian/Building Manager
Name
Home Address
City
State
Zip
Home Phone
Cell Phone
Email
Emergency Contact Info
Do you want this person added to the notification system?    Yes   No
 
Bus Driver
Name
Contact Person
Address
City
State
Zip
Phone
Fax
Cell of Contact Person
Email
 
Sub-contracted Bus Company
For schools using an outside company
Name
Contact Person
Address
City
State
Zip
Phone
Fax
Cell of Contact Person
Email
 
school List Contact
Please list off premises contact person who can be contacted for your school list.
Name
Home Phone
Cell Phone
Email

Additional Contact
Are there any other staff members you would like listed as contacts? Yes   No
Demographics
Number of Students*
Grades *
To *

    Boys        Girls
Number of Staff *
Number of students with mobility difficulties *
Number of staff with mobility difficulties *
Does school have surveillance cameras? *   Yes   No      If yes are they recorded? *   Yes   No
* = Required Fields
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