Child Information Form 2019-2020

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Please fill out this form for EACH child you have in childcare. This form is good for one academic year, and will need to be resubmitted at the beginning of the Fall Semester.

As the parent or legal guardian of the child, it is your responsibility to notify the Childcare Facilitator of any changes that need to be made for your child(ren)'s form.

If you have any problems with submitting this form, please email community.formation@asburyseminary.edu.

Child's First Name *

Child's Last Name *

Child's Age *

Child's Date of Birth *

YYYY

Sibling's Names (enter all on one line)

*Please remember to fill out a new form for each child who will be participating in childcare activities.

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