Student Contact Verification Form

Changes to the current contact information that we have on record can be made by completing the information below.

Address changes CANNOT be completed with this form. ANY change of address or guardianship requires documentation to be immediately provided to Central Registration at Cutchogue East Elementary School, 34900 Main Road, Cutchogue, NY 11935 (631) 734-6049.

Student No. 1
Student No. 2
Student No. 3
Student No. 4
Home Address:
Mailing Address:
Home Telephone Number:
Father's Name:
Father's Address (if different):
Father's Home Number (if different):
Father's Cell Phone Number:
Father's Work Number:
Father's Email Address:
Mother's Name:
Mother's Address (if different):
Mother's Home Number (if different):
Mother's Cell Phone:
Mother's Work Number:
Mother's Email Address:
Telephone Number for Attendance Calls (JSHS Only):
Emergency Contact #1:
Home Telephone Number:
Cell Phone Number:
Work Telephone Number:
Relationship to Student:
Emergenct Contact No. 2
Home Telephone Number:
Cell Phone Number:
Work Telephone Number:
Relationship to Student:
Emergency Contact No. 3:
Home Telephone Number:
Cell Phone Number:
Work Telephone Number
Relationship to Student:
Any other information you feel the school district should be made aware of: