New Student Survey

If you are new to Mr. Martocchio’s class, please complete this survey.

* Indicates required field

Name of student you want Mr. Martocchio to use. *

First

Last

Parent/Guardian Name *

First

Last

Phone Number *

Email *

Additional Parent/Guardian Name *

First

Last

Phone Number *

Email *

Additional parent/guardian name *

First

Last

Phone Number *

Email *

additional parent/guardian name *

First

Last

Phone Number *

Email *

Please provide relative/friend name(s) and contact(s) in case Parent(s)/Guardian(s) can not be reached. *

Please provide the name(s) and relation(s) of the person/people who is/are allowed to pick up your child. *

Please list any allergies your child has. If none, enter "none". *

Everything You Need To Know About Seminar & InstructorDave.org *

I (we) have read the Everything You Need To Know About Seminar have become familiar with the other material found at InstructorDave.org

Photography and Video Opt In/Out *

I (we) DO want my (our) child(ren) to be photographed and in videos. I (we) DO NOT want my (our) child(ren) to be photographed or in videos.

Physical Education in Pioneer Park *

I (we) give permission for our child to go to Pioneer Park for recess and/or Physical Education under the supervision of the school P.E. teacher and/or Dave P. Martocchio

Class Contact List *

It is OK for my contact information to be published in a class roster to be distributed to all the parents/guardians. It is NOT OK for my contact information to be published in a class roster to be distributed to all the parents/guardians.

Visible Email Address *

It is OK for Dave Martocchio to send bulk emails to the parents/guardians of his students where my email address is visible. I need my email address to be kept from being seen by other parents/guardians. I request Dave Martocchio to Blind Carbon Copy me when sending bulk emails.

FIRST WEEK OF SCHOOL CONFERENCE
If you would like to have a conference with Mr. Martocchio during the first week of school, please click HERE . You are not required to have a conference with Mr. Martocchio. I will not have any new information to share with you. It would be a time for you to ask questions or share information with me.

FALL & SPRING CONFERENCES
For information and to sign up for a conference, please click HERE.

Please describe your idea(s). *

What are your child’s strengths? *

What are your child’s weaknesses? *

What is the best way for Mr. Martocchio to meet the needs of your child? *

What motivates your child and what discourages your child? *

What are your child’s biggest needs? Please list by priority. *

What frustrates, discourages, and/or triggers your child? *

What academic, social, emotional, personal, and/or any other goals do you have for your child this year? *

Please write any additional Comments, Additional Information, Thoughts, etc. here. *

Thank you! I look forward to working with you and your child this year.

Mr. Martocchio