Verona Area School District Census Survey

Verona Area School District Census Survey
Para obtener ayuda con la traducción al español, envíe un correo electrónico a vasd-translators@verona.k12.wi.us
o llame al (608) 653-1019 or (608) 845-4491.
Adult Household Members

Please enter the name(s) and contact information of the adult household members below.
Adult 1*

First NameLast Name
Relationship to child(ren):*
Phone Number*

Area CodePhone Number
Email
example@example.com
Adult 2

First NameLast Name
Relationship to child(ren):
Phone Number

Area CodePhone Number
Email
example@example.com
Household Address
Household Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
All Children Not Currently Attending VASD
Please enter the full name, Date of Birth, and Gender for all children in your household not currently attending a VASD School. You must hit SAVE after each entry.*
Does the child(ren) listed above have any school age siblings attending Verona Area School District?*

YesNo
Please list sibling names below. You must hit SAVE after each entry.*
Electronic Signature

The electronic signature below and its related field(s) are treated by Verona Area School District like a handwritten signature on a paper form (Board Policy 773, Use of Electronic Signatures)
Name of Person Submitting Form*

First NameLast Name
Date*

MonthDayYear
Date
Enter the message as it's shown*
Should be Empty:

Household Address