Family Information Sheet 2024-25
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Email *
Child's Name *
Date of Birth *
MM
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DD
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Address *
Parent #1 Name (Who to contact first) *
Parent #1 Email *
Parent #1 Cell Phone Number *
Parent #1 Work or Alternate Phone Number (if any)
Parent #2 Name
Parent #2 Email
Parent #2 Cell Phone Number
Parent #2 Work or Alternate Number (if any)
If you can't reach me, please call: *
Relationship to Child *
Cell Phone number *
AlternatePhone Number (if any)
Address *
Child's Doctor's Information (Name & Phone Number) *
Allergies *
If Yes please list all allergies
Please list all medication child is currently taking
Listed below are the people I give permission to release my child to for dismissal or an emergency (written permission required beforehand) with their cell phone numbers and addresses (press Enter to list names separately)
I agree to have my contact information shared with the members of his/her classroom for use on the class list.  This information will not be used for any other purpose other than for communication with the parents.
Clear selection
I acknowledge that I have received and read the Midway Jewish center Early Childhood Center's Parent Handbook. Please enter name here to be used as a signature to acknowledge that the Parent Handbook was read
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Photo Release Form
If the person signing is under age 18, there must be consent by a parent or guardian as follows: I hereby certify that I am the parent or guardian and do hereby give my consent without reservation to the foregoing on behalf of this person. By entering your name you are signing the photo release form.
Please enter name here to be used as a signature to the Agreements *
Today's Date *
MM
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DD
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YYYY
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