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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: ___