Child Information Form

Child

Parents / Guardians

Other Contacts

Medical

Door

This information will be kept on file, and used in the event of an emergency.

Fill out the form below, and verify all information is accurate

Sex

Male Female

Parent / Guardian Information

Other Contacts

Others to be contacted within the immediate area if parents or guardian cannot be contacted in case of emergency.

Authorized to pick up child?

Yes No

Authorized to pick up child?

Yes No

Authorized to pick up child?

Yes No

Authorized to pick up child?

Yes No

Medical

Door

To All Parents/Legal Guardians:

We want to welcome you to our Academy. As you may have noticed the front door requires a security code to enter. To make things simpler, we are asking you to pick out your own codes. If we have not received a code from you, one will automatically be assigned. We also ask that you do not share your codes with anyone. Parents and legal guardians only!! If someone other than parent or legal guardian is picking up your child, we can easily buzz them in the door. This is to ensure their safety and your peace of mind. If you have any questions, please contact us at (407) 886-0015. We appreciate your cooperation and support.
Thank You.

Michelle Brown, Director