1. Child’s Name _________________________
Parent/Guardian Name
____________________________________
Address: ______________________________________
______________________________________________
Phone Numbers:
Hm: _________________________________________
Cell: _________________________________________
Work: ________________________________________
Email: _______________________________________
Age:_______Last grade completed: ______________
Medical Information
Medical or other information we need to know.
(Please include food allergies.)
_____________________________________________
_____________________________________________
Emergency Contacts (other than listed above)
Name ________________Phone # ________________
Name ________________Phone # ________________
Dismissal Information
Who may pick up your child each evening?
_____________________________________________
Does your child attend Sunday School ____________
May we have permission to photograph your child
and use them in promotions? ___________________