Child Custody Form - Sunny Hollow Montessori printable pdf download

Child Custody Form - Sunny Hollow Montessori

CHILD CUSTODY FORM

Student Name __________________________________________________________________

(Please print)

Parent 1 Name: _________________________________________________________________

(Please print)

Parent 2 Name:

________________________________________________________________

(Please print)

Guardian’s Name: _________________________________________________________________

(Please print)

Are there custodial issues with the above-mentioned child?

Yes

__________

If custodial issues are involved, please provide the information requested below:

Are there any restrictions legally placed upon either parent’s right to receive information about or pick up, the

student named above?

Yes

__________

If yes, a copy of decree needs to be on file at the school.

If separated or divorced, which parent(s) or person has custody of student?

Parent 1______ Parent 2______ Both______ Other________________________________

May we contact non-custodial parent in case of emergency?

Yes______ No ______

If no, a copy of decree needs to be on file at school.

Is student allowed to leave with non-custodial parent?

Yes______ No ______

If no, a copy of decree needs to be on file at school.

Note: It is the parents’ responsibility to provide the school with a written schedule of drop off and pick up information so the school is

aware of which parent to contact in case of emergency. This must be provided in writing and updated as needed.

636 Mississippi River Blvd. South

St. Paul, MN 55116

Ph. 651-690-2307 Fax 651-690-0684

Custody Issues Form.doc

Child Custody Form - Sunny Hollow Montessori