Child Information Sheet - Ymca
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1
2CHILD INFORMATION SHEET
Aquatics
Youth & Preschool
C
’
: ________________________C
’
L
N
__________________________
HILD
S FIRST NAME
HILD
S
AST
AME
G
: ___________ A
: __________ B
(MM/DD/YYYY):_______________________
ENDER
GE
IRTH DATE
P
________________________ P
________________________
ARENT #1 Name:
ARENT #2 Name:
A
___________________________________________ P
C
: __________________
DDRESS
OSTAL
ODE
P
#1(
) __________________________P
#2 (C
) _________________________
ARENT
WORK
ARENT
ELL
P
#1 (
) __________________________ P
#2 (C
) _________________________
ARENT
WORK
ARENT
ELL
EMAIL ADDRESS: ________________________________PHONE: (HOME) __________________
A
: _____________________________________________________________
LTERNATIVE CONTACT
R
: _____________________________________________________________
ELATIONSHIP TO CHILD
P
: (H
) _____________________(W
)__________________(C
)_________________
HONE
OME
ORK
ELL
A
: _______________________________________________________
LBERTA HEALTH CARE NUMBER
P
.
LEASE LIST ANYONE WHO MAY BE PICKING UP YOUR CHILD ASIDE FROM THE PARENTS LISTED ABOVE
A
NYONE WHO IS NOT ON THIS FORM WILL NOT BE PERMITTED TO PICK UP YOUR CHILD FROM THEIR REGISTERED
*P
ID
*
.
PROGRAM UNDER ANY CIRCUMSTANCE
HOTO
IS REQUIRED AT THE TIME OF PICK UP
N
:
P
#:
R
:
AME
HONE
ELATIONSHIP
__________________________
_____________________
______________________
__________________________
_____________________
______________________
__________________________
_____________________
______________________
__________________________
_____________________
______________________
__________________________
_____________________
______________________
__________________________
_____________________
______________________
P
LEASE LIST ANYONE WHO IS NOT ALLOWED TO HAVE CONTACT WITH YOUR CHILD (MUST HAVE COURT
ORDERED DOCUMENTS IN ORDER TO ENFORCE NO CONTACT):
_________________________________________________________________________
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