Information Sheet

Child’s name (including nickname): ____________________________________________

Child’s address: ______________________________________________________________

Child’s telephone #: ____________________________ Birthday: ____________________

Siblings at school: Name Grade

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Authorized to pick-up your child:

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Allergies and or medications:

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Other schools attended:

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Mother’s name: _______________________________________________________________

Telephone number and email: _________________________________________________

Father’s name: ________________________________________________________________

Telephone number and email: _________________________________________________

Emergency contact if parents cannot be reached: _______________________________

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Insights to your child that may be helpful: ______________________________________

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