Enrollment
Fulltime/Part time/Summer Kamp |
Child's Name:___________________ Sex:_______ DOB:____________
Address:__________________________________ Home #:__________
Fathers Name:__________________ Mothers Name:___________________
Fathers Employer:_______________ Mothers Employer:________________
Fathers Wk #:__________________ Mothers Wk #:____________________
Fathers Cell:____________________ Mothers Cell:____________________
The person who should be contacted first in the case of an emergency if the parent can't be contacted is:_______________________ #'s:____________
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Child's Doctor:_______________________ Phone:_____________________
Child's Dentist:_______________________ Phone:_____________________
Does your child have any food allergies? yes/no
Does your child have any other allergies? yes/no
Does your child have any dietary restrictions? yes/no
Please explain any "yes" answer here:_______________________________
Toilet training? yes/no working on
Past illness?_____________________________________________________
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I hereby Authorize this facitlity to care for my child during the time he or she is in the facility in accordance with the provisions of LA. civil code ART2997(7), I hereby authorize the director of Kidz Karousel, LLC to obtain and consent to emergency medical treatment for my child while under their care, in the event that said director is unable to contact me.
Parent's Signature______________________ Date: ____________________
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For School Use Only:
Date of Admission:_____________ Start Date:______________
Classroom:________________ Registration year:____________
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