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					                  PARENTS/CHILD INFORMATION

Child’s Name:______________________ Nickname:_______________
Birthdate:___________________ Date enrolled:__________________




          Mother: ___________________ Birthdate:________________
Address:_______________________________________________________
City: _________________________________________State ____ Zip
Home Phone __________Cell Phone____________Pager_____________
Mother’s
Employment:_________________________________Phone_____________
Address:________________________________________________________
Occupation _____________________________ Work Hours:___________
Email address:___________________________




           Father: __________________Birthdate:________________________
Address:_____________________________________________________________
City: _________________________________________State ____ Zip
Home Phone _______________Cell Phone ____________Pager_____________
Father’s
Employment_______________________________________ Phone____________
Address:_____________________________________________________________
Occupation _____________________________ Work Hours:________________

Parents are:
Married    Divorced    Live Apart      Live Together    Single
If separated do you have Full Custody or Shared Custody?______________

If you have legal documents preventing your spouse from picking up your
child you will need to bring me a copy otherwise I have no legal right to
stop a parent from taking his/her child from my home. All I can do is call
you to contact the local authorities.

				
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