Your Child's Information

      

Scheduled Attendance

Moday
Tuesday
Wednesday
Thursday
Friday

Allergies

Child's Primary Doctor

Child's Primary Dentist

Health History

Operation/Serious Injuries

Current Medications

Physical Limitations

Dietary Limitation

Are there any activities you would prefer your child NOT to participate in?

Photo Permission

Additional Comments/Information

Parent / Guardian Information

Emergency Contacts - Please list between 3 and 5

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