Child Information
All REQUIRED fields marked with *
Parent/Guardian Information #1
(This is who we will send the invoice to)
Parent/Guardian Information #2
Please Identify 2 People Who May Be Called for an Emergency if You Are Not Available.
Dismissal
My child will be picked up at dismissal by myself or one of the following individuals:
Photo/Video/Interview Consent
I certify that I am the parent or legal guardian of Name of child*, whose date of birth is Month/Date/Year*.
Emergency Medical Care
Following emergency medical care, my child may be released to the following people:
Health/Insurance Information
Parent/Guardian Contract & Consent
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