BJEOC HS Family Communication Form

Beaufort Jasper EOC Head Start

Family Communication Form
Child Name*

First NameMiddle NameLast Name
Parent Name*

First NameMiddle NameLast Name
Center*
Address*
Home Phone
Work Phone
Mobile
Email
example@example.com
There may be times throughout the year that Head Start would like to send a brief text message to parents (ex. event reminds, center information, family service information, etc Since text messaging is not free; parents who want to receive texts must complete the information below giving permission.
Text Messaging Consent*

Yes, I want to receive text messages from my child`s Head Start center to the mobile numbers indicated above.No, I do not want to receive text messages at this time.
Email Consent*

Yes, I want to receive emails from my child's Head Start center. I have provided the email address above.No, I do not want to receive emails from my child's Head Start Center.
Emergency Contact Information
1. Name*
Relationship*
Phone #*
2. Name
Relationship
Phone #
3. Name
Relationship
Phone #
Parent Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

Beaufort Jasper EOC Head Start