Contact Information Form

Pre-K Contact Information

 

 

Child’s Name ____________________________________ DOB _____ /____/200___

 

Any food allergies:________________________________________

 

On any medications daily: ___________________________________

 

__________________________________________________________

 

Additional Information you would like to share about your child:

__________________________________________________________

__________________________________________________________

 

Mother /Guardian Name _________________________________________

 

Address _______________________________________________________

 

Phone # _________________________ Work #_____________________

 

Cell # _________________________

 

Father / Guardian Name _________________________________________

 

Address (if different from above)____________________________________

 

Phone # _________________________ Work #______________________

 

Cell # _______________________

 

Emergency Contact Name: ___________________________________

 

Emergency # ______________________________

 

Relationship to Child: ________________________