Roster & Household Contact Information

MA - Roster & Household Contact Information

Families should update their household contact details with the most current information in the following categories. These details will be kept on file in the academy office and will be used to contact parents throughout the year. Since communication with parents is primarily paperless, it is important to include current email addresses for all parents. Please contact the school office with any updates to your email addresses.

Child's Name*
First Last
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent 1 Name*
First Last
Parent 1 Email*
Parent 1 Preferred Phone*
Parent 1 Preferred Phone is:*
- Cell
- Home
Parent 1 Alternate Phone is:
Parent 1 Alternate Phone is:
- Cell
- Home
Parent 1 Work Phone
Parent 2 Name
First Last
Parent 2 Email
Parent 2 Preferred Phone
Parent 2 Preferred Phone is:*
- Cell
- Home
Parent 2 Alternate Phone
Parent 2 Alternate Phone is:
- Cell
- Home
Parent 2 Work Phone
Unless otherwise notified, Miriam Academy makes its Parent Roster - including address, home phone number, cell phone numbers, and emails - available to all the families in our academy community. Please indicate if you do not want your information included in this roster.
- I do NOT want our address, home & cell phone numbers, and emails on the Parent Roster.
Parent / Guardian Signature*
First Last
Date*
Date Format: MM slash DD slash YYYY
Pin Number*
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Roster & Household Contact Information

MA - Roster & Household Contact Information

Miriam School

Grades K-8

Miriam Academy

Grades 9-12

Miriam Learning Center

Support Services

Miriam Switching Post

Resale Shop

Support Miriam

MA - Roster & Household Contact Information

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