Le site-web de Mme Monique

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Child’s name: ____________________________________________________________

 

Date of birth: ____________________________________________________________

 

Address: ________________________________________________________________

 

Home phone: ____________________________________________________________

 

Best time to call home: _____________________________________________________

 

Mother/Guardian’s name: __________________________________________________

 

Work phone number: ______________________________________________________

 

Father/Guardian’s name: ___________________________________________________

 

Work phone number: ______________________________________________________

 

Siblings                                    Name(s)                       Age(s)                          Grade(s)

                                               

______________        _________                  ______

                                               

                                                ______________        _________                  ______

                                   

                                                ______________        _________                  ______

                       

 

Child’s allergies: _____________________________________________________

 

Extra-curricular activities: ___