Parental Questionnaire: Important Information

Child's name

Child's surname

Who else can pick up the child? (Name and surname, relationship)

Who can be listed as an emergency contact if you cannot be reached? (First and last name, phone number)

Does the child have any allergies (to food, medications, insect bites, etc.)?

Does your child have any medical conditions or chronic illnesses that we should know about (e.g. asthma, epilepsy, diabetes)?

Does the child take any medications that may be needed while in the program?

How would you like to provide us with information about vaccinations?

I'll attach a copy now.

I'll bring the file in person

Signature

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