Fizzix/Astro Student Info Submission 2011


Taylor use only! Nothing will be used for any purpose other than direct class material. I won't even send this info to the Boy Scouts. Unless they pay. Lots...
1. Name / Grade / House

2. ID#

3. Counselor

4. Parent's phone number(s)

5. YOUR email(s)

6. YOUR PARENT'S email(s) (Optional, of course.)

7. Address

Street

Town, ZIP

8. Date of Birth (For class parties, of course.)

9. Book Number

Note: YOU will get an automatic reply from my server for this submission. Ignore it if you'd like.




Name:     Email: