1.	What type of messages would you like to receive regarding school closings and reminders?* A phone number is required for any type of message.
	Phone :    Text:    E-mail:

2.	Name:*
	First:   Last:   Mailing Address:   If you are a parent, what is the name of your child:   What program your child is enrolled in:

3.	Please check one of the following options that best describes yourself:*
	Student attending a BOCES Program Parent of a student that attends a BOCES Program Sullivan County Resident Local District Employee Business Owner Resident of another County

4.	Since you indicated that you would like to receive school closing messages and notices please complete the following information.
	Primary   Secondary Home Phone Number(s):     Cell Phone Number(s):     E-mail Address(s):

5.	What other type of information would you like to BOCES to provide?