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Blue Card Survey Form

  • WELCOME!

    Dear Parents/Guardians:

    Welcome to Maspeth High School!

    Please fill out this mandatory survey in order to communicate essential information to Maspeth High School, especially Accepted Student Orientation and Freshman Orientation. As a reminder, you will need the following information:

         • Student Biographical Data: 
              Name, Home Address, Email, Home Phone, Cell Phone, Student ID/OSIS number (Public school students can get this from their guidance counselor. Private school students, use 888888888), Date of Birth, Gender, and Ethnicity.
        • Parent/Guardian Biographical Data: 
              Name, Home Address, Email, Home Phone, Cell Phone, Work Phone, Preferred Language of Communication, Names of Siblings, and Schools Siblings Attend.
         • Emergency Contact Information (Blue Card Information): 
              In the event of an emergency where we cannot reach the parent/guardian of record, choose three people who can get to Maspeth High School to pick up a sick/injured student. All contact information is required for each of the people selected.
         • Student Medical Information: 
              Primary physician contact information, known allergies, 504/IEP information for student with special needs, etc.
         • Alumni Status:
              Is any member of the immediate family a Maspeth High School alum? (Argonaut)
    Once you begin the survey, you cannot save information and continue at a later time. It should take approximately 10-15 minutes to complete the process.

    Please do not hesitate to call the Main Office at 718-803-7100 if you require assistance of any kind.
    Thank you!
     
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  • BIOGRAPHICAL INFORMATION - STUDENT

     
State*
Answer Required
Student's Gender*
Answer Required
Student Currently Attends The Following*
Answer Required

  • PARENT/GUARDIAN INFORMATION

     
  • PARENT/GUARDIAN #1 (Primary Residence)
     
Relationship*
Answer Required
State*
Answer Required
Parent/Guardian #1 Spoken Language Preference*
You may select more than one
Answer Required
Parent/Guardian #1 Written Language Preference*
You may select more than one
Answer Required
  • PARENT/GUARDIAN #2
     
Relationship
Answer Required
Same address as PARENT/GUARDIAN #1?
If NO, please complete address below
Answer Required
State
Answer Required
Parent/Guardian #2 Spoken Language Preference
You may select more than one
Answer Required
  • STUDENT SIBLINGS - IN A NYC DEPT OF EDUCATION PUBLIC SCHOOL
     

  • EMERGENCY CONTACT INFORMATION

     
  • IN THE EVENT A STUDENT MUST LEAVE SCHOOL EARLY, THE STUDENT WILL ONLY BE RELEASED TO A PARENT/GUARDIAN OR A PERSON LISTED ON THE FORM BELOW.
     
  • IN THE EVENT WE CAN NOT REACH EITHER PARENT/GUARDIAN, LIST BELOW THE FIRST PERSON WHO SHOULD BE CONTACTED IN CASE OF AN EMERGENCY.
Emergency Contact #1 Spoken Language
Answer Required
Emergency Contact #1 Relationship to Student
Answer Required

IN THE EVENT WE CAN NOT REACH EITHER PARENT/GUARDIAN, LIST BELOW THE SECOND PERSON WHO SHOULD BE CONTACTED IN CASE OF AN EMERGENCY.

Emergency Contact #2 Spoken Language
Answer Required
Emergency Contact #2 Relationship to Student
Answer Required

IN THE EVENT WE CAN NOT REACH EITHER PARENT/GUARDIAN, LIST BELOW THE THIRD PERSON WHO SHOULD BE CONTACTED IN CASE OF AN EMERGENCY.

Emergency Contact #3 Spoken Language
Answer Required
Emergency Contact #3 Relationship to Student:
Answer Required
  • IF THERE IS A PERSON WHO MAY NOT LEGALLY HAVE ACCESS TO THE STUDENT, PLEASE INDICATE BELOW (DOCUMENTATION MUST BE PROVIDED):
     
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Is there an Order of Protection?
Answer Required

  • MCKINNEY-VENTO ACT (STUDENTS IN TEMPORARY HOUSING)

     
  •  
  • This form is intended to address the McKinney-Vento Act 42 U.S.C. 11435, and must be completed for each student. The information you provide is confidential. Your child will not be discriminated against based upon the information provided. Please complete the following questions regarding the student’s housing in order to help determine services the student may be eligible to receive.
     
PLEASE IDENTIFY THE STUDENT'S CURRENT LIVING ARRANGEMENTS. PLEASE CHECK ONE BOX*
Answer Required
IS THE STUDENT IN THE PHYSICAL CUSTODY OF A PARENT OR GUARDIAN?*
Answer Required

  • HEALTH INFORMATION

     
     
  • NAME OF PRIMARY PHYSICIAN
     
State*
Answer Required
DOES THE STUDENT HAVE ANY 504 SERVICES?*
Answer Required
DOES THE STUDENT HAVE AN INDIVIDUALIZED EDUCATION PLAN?*
Answer Required
DOES THE STUDENT HAVE HEALTH INSURANCE?*
Answer Required
IF THE STUDENT DOES NOT HAVE HEALTH INSURANCE, ARE YOU WILLING TO SHARE CONTACT INFORMATION TO LEARN ABOUT INSURANCE OPTIONS?
Answer Required

PARENTAL / GUARDIAN OPT OUT

  • This section will allow parents/guardians to opt out of standard programs at Maspeth HS.
     
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  • Federal law requires the New York City Department of Education (DOE) to provide names, addresses, and telephone numbers of 11th and 12th grade high school students to military recruiters and institutions of higher education that request this information, except where the parent or student opts out by notifying the DOE in writing that he/she does not consent to release this information. While we are committed to protecting the confidentiality of our students, we must comply with the law.
     
Parents/guardians and students who do not want contact information disclosed to military recruiters and/or institutions of higher education must click the buttons below.
Answer Required
  • The New York City Department of Education offers an HIV/AIDS prevention program as part of an ongoing comprehensive health education program. In addition, all high school students in grades 9-12 are permitted to request free condoms at their school. As a parent or guardian, you may ask the school not to give your child condoms. This is referred to as a parent opt-out. You are not permitted to make this request if your child is: 18 years of age or older; has been or is currently married; is a parent, and/or is entitled under law to give consent for himself/herself.
     
My child is not permitted to participate in the Condom Availability program.
Answer Required
  • The Parent-Teacher Association of Maspeth High School requests the contact information of each family to provide information and support services. If you do not permit the school to share your name, telephone number, and email information, please click the button below.
     
I do NOT permit the school to share my contact information with the PTA.
Answer Required
  • Maspeth High School is often visited by guests exploring best practices in education. In addition, the school conducts a large number of special events and competitions which are photographed and videotaped. Your consent is for the use of such material by Maspeth HS or other non-profit agencies for educational, public service, or health awareness purposes only.
     
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Your consent to hereby releases the New York City Department of Education and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.
Answer Required

  • ALUMNI LEGACY

     
  • ARE ANY OF THE SIBLINGS A MASPETH HIGH SCHOOL ALUM?
     
  •  
SIBLING #1
Answer Required
SIBLING #2
Answer Required

  • LEGAL AFFIRMATION

     
Confirmation Email