BROOKLYN JUNIOR HIGH
School Year 2008-2009
NAME ______________________________________________________________________________
ADDRESS___________________________________________________________________________
PHONE NUMBER: home ( )________________________ other( _ )________________________
EMAIL ADDRESS____________________________________________________________________
EMERGENCY CONTACT___________________________________ ____________________________ _________________________
(Name) (Phone) (Relationship)
AVAILABILITY:
Monday: hours ___________________ Thursday: hours ___________________
Tuesday: hours ___________________ Friday: hours ___________________
Wednesday: hours ________________ notes: ___________________________
AREAS OF INTEREST: (please check)
