Family Information Form

Please complete one form per family.

PARENT INFORMATION

Parent 1 Name *

First

Last

Parent 1 Cell *

Parent 1 email *

Parent 1 Occupation

Parent 1 Firm

Parent 1 Work Phone

Parent 2 Name *

First

Last

Parent 2 Cell *

Parent 2 email *

Parent 2 Occupation

Parent 2 Firm

Parent 2 Work Phone

FAMILY INFORMATION

Address *

Address Line 1

Address Line 2

City

State

Zip Code

First Child

Second Child

Third Child

Fourth Child

Additional Children

Date of Birth

GRANDPARENT INFORMATION

The children create holiday gifts that are sent to their grandparents. Please provide us with current mailing information.

CELC Grandparents 1

Names

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email Addresses (Grandparents 1)

CELC Grandparents 2

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email Addresses (Grandparents 2)

EMERGENCY CONTACTS (OTHER THAN PARENTS)

Emergency Contact #1 Name *

Emergency Contact #1 Phone *

Emergency Contact #2 Name *

Emergency Contact #2 Phone *

DISMISSAL PROCEDURES

In order to take every possible safety measure at dismissal, we require that each person, other than a parent, authorized to pick up your child be known to your child's teacher and to the director. In the event that someone not listed below will be picking up your child, please call the school with the individual's name and physical description.

Caregiver Name

Caregiver Phone

In the event that your child is not picked up from school and we are unable to notify you or any of your contacts, we will call another parent from the school to take your child to their home until you are contacted. Please indicate two other parents, preferably parents of your child's friends, with whom we may leave your child.

CELC Parent Contact #1 *

CELC Parent Contact #2 *

FAMILY INFORMATION FORM

Family Information Form

Please fill up form below to register: