Printable Form

Gender




Child lives with:


Care Needed:

Preschool

Afterschool

Full day on School recess (afterschool only)


Allergies:

Other relatives or friends who live with your child:

Name Relationship

List your child's favorite activities, hobbies, sports, people, food, etc:

Afterschool students only:

______________________________________________________________________________

Authorization to Photograph

I give permission for my child to be photographed or video-taped during school activities/events for newspapers or other publicity.

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