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Little Angels Registration 11-12

This document is a registration form and emergency contact information for Little Angels Preschool for the 2011-2012 school year. It collects basic information about the child such as name, date of birth, allergies, contact information for parents/guardians, and emergency contacts. It also requests the child's class schedule preference and medical contact details in case of emergency when parents cannot be reached. The form is to be signed by a parent or guardian to authorize medical treatment if needed.

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Guardian Angels Catholic Church
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32 views1 page

Little Angels Registration 11-12

This document is a registration form and emergency contact information for Little Angels Preschool for the 2011-2012 school year. It collects basic information about the child such as name, date of birth, allergies, contact information for parents/guardians, and emergency contacts. It also requests the child's class schedule preference and medical contact details in case of emergency when parents cannot be reached. The form is to be signed by a parent or guardian to authorize medical treatment if needed.

Uploaded by

Guardian Angels Catholic Church
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Little Angels Preschool

REGISTRATION FORM & EMERGENCY INFO.


2011-2012
Date: _________________________
Childs Name: ___________________________________________________________
Allergies: _______________________________________________________________
Date of Birth: ________________________
Gender: ________________
Address: ________________________________________________________________
Mothers Name: _____________________ Address: ____________________________
Phone: (H)
_____________________
____________________________
(W)
_____________________
Fathers Name: _____________________
Phone: (H)
_____________________
(W)
_____________________

Address: ___________________________
___________________________

Email: _____________________________________
Daycare Providers Name: __________________________________________________
Phone: _____________________________________
Emergency Contacts: (If parents can not be reached)
1) Name: _____________________________ Phone: ____________________________
Address: ___________________________ Relationship: _______________________
2) Name: _____________________________ Phone: ____________________________
Address: ___________________________ Relationship: _______________________
Class: (Please check) Child must be 3 years old by October 1st for the T-TH a.m. class
or 4 years old by October 1st for the M, W, F a.m. class, and 4 years old by September 1st
for M-F pm class.
9:00 a.m. to 11:30 a.m.

Mon/Wed/Fri _____________________________
(4-5 year olds)
1:00 p.m. to 3:30 p.m.
Mon thru Fri _____________________________
(4-5 year olds)
9:00 a.m. to 11:30 a.m.
Tues/Thurs _____________________________
(3-4year olds)
Doctor ____________________
Address__________________ Telephone________
Hospital ________________________________________________________________
Dentist ____________________
Address__________________ Telephone________
Authorization to treat if unable to reach one of the above:
Health Information/Needs:
________________________________________________________________________
________________________________________________________________________
Parent/Guardian Signature: _________________________________________________

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