EmailMe Form - CPA HS Change of Adult

CPA HS Change of Adult

Legal Guardian (LG): The adult legally responsible for the student; parent or legal guardian. (In some situation additional legals documents may be needed to add)

Learning Coach (LC): The adult, designated by the legal guardian, to actively monitor, assist, and motivate the student on a daily basis to ensure academic progress and adherence.

Emergency Contact (EC): A family‐designated adult who is not the student’s LC or LG. This contact will only be used for emergencies purposes.

Legal Guardian's name *
Email *
List if students *

Students Grade Level Student ID

Student 1

Student 2

Student 3

Student 4

Student 5
Add/Remove Legal Guardian
Add
Remove
Add/Remove Learning Coach
Add
Remove
Add/Remove Emergency Contact
Add
Remove
Legal Guardian (LG):
The adult legally responsible for the student; parent or legal guardian. Any decisions having to do with enrollment, registration and/or withdrawal will need to be done by the legal guardian only. For ANY changes the area below must be signed by the legal guardian.
LG - Adult Information *
First Last
LG Phone Number *
### - ### - ####
LG Email *
New LG Address *

Street Address City State / Province / Region Postal / Zip Code
Learning Coach (LC):
The adult, designated by the legal guardian, to actively monitor, assist, and motivate the student on a daily basis to ensure academic progress and adherence. The role and responsibilities of the LC varies based on the student’s grade level. If the LG chooses to select someone other than themselves as the LC, please note that LG are still ultimately responsible in ensuring adherence to school policies.
LC- Adult Information *
First Last
LC Phone Number *
### - ### - ####
LC Email *
New LC Address *

Street Address City State / Province / Region Postal / Zip Code
Emergency Contact (EC):
A family‐designated adult who is not the student’s LC or LG. This contact will only be
used for emergencies purposes. EC information becomes particularly important when your student is participating in live events, such as testing and field trips. They also become important when school staff cannot
get ahold of the LC, LG or student by phone or by email.
EC - Adult Information *
First Last
EC Phone Number *
EC Email *
New EC Address *

Street Address City State / Province / Region Postal / Zip Code
Phone Number Changes needed?
If you need a change please give us enough information below to be able to do that. Limits some emails if we have good details.
- Student Home Number
- LC / LG Name and Number to change to

	Students Grade Level	Student ID
Student 1
Student 2
Student 3
Student 4
Student 5