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