Form
Childs Full Name
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Childs Age
Grade child is going into
Childs School
Any Known Allergies
Primary language of child
Child Shirt Size
Can your child indicate the need to use the restroom?
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Yes
No
Any known medical conditions?
Any hearing, speech, or vision problems?
Any food restrictions?
Parent Information
Parent 1 Name
Phone Number
Email
Address
Suburb/City
State
Postcode
Country
Parent 2 Name
Phone Number
Email
Address
Suburb/City
State
Postcode
Country
Emergency Contacts
Emergency Contact Full Name
Emergency Contact Phone Number
Emergency Contact Relationship To Child
Pick Up Persons
1st approved pickup person name
1st approved pickup person number
Relationship to Child
2nd approved pickup person name
2nd approved pickup person number
Relationship to Child
3rd approved pickup person name
3rd approved pickup person number
Relationship to Child
Important Information About Your Child
Anyone NOT allowed contact or to pick up your child
Name of Doctor
Doctors Phone Number
Name of Dentist
Dentist Phone Number
Preferred Hospital
Upload Insurance Card
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