Children's Registration Form

Child's Name: _________________________________________________________________

Parents/Guardians Name: ________________________________________________________

Address: ______________________________________________________________________

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Telephone Number: _____________________________________________________________

Date of Birth: _____________________________Current Age: __________________________

Current School Grade: ___________________________________________________________

Transportation provided by Parent/Guardian: ________________________________________

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Name of person (s) who are able to pick up the child names above: ________________________

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Does your child have any allergies? (Any foods that they should not have?): ________________

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Does your child have any special needs that the workers need to be aware of? _______________

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