Directory Form

Would you like to be able to contact and be contacted by other parents?

Make sure you are listed in the School Directory to be published in October.

There is no charge to be included. Only families included in the directory will receive a copy.

You may include as much or as little information as you'd like. Please be aware that any information provided on this form will be published in the directory. If you do not wish information to be included, please do not list it on the form.

Child's First Name

Child's Last Name

Child's Grade

Child's Teacher

2nd Child's First Name (Omit if you only have one child)

2nd Child's Last Name

2nd Child's Grade

2nd Child's Teacher

3rd Child's First Name (Omit if you only have 1 or 2 children)

3rd Child's Last Name

3rd Child's Grade

3rd Child's Teacher

Parent(s)'s Names

Street Address (Optional)

Zip Code (Optional)

Home Phone Number (Optional)

Cell Phone Number (Optional - Include area code if not 914)

Additional Cell Phone (Optional - Include area code if not 914)

E-mail Address (Optional)

Patricia A. DiChiaro School PTA