Children's Enrollment Form

Father's Home Address (if different from child's)
Employer's Address
Mother's Home Address (if different from child's)
Employer's Address
Child's Living Arrangements: (check one)
The child may be released to the person(s) signing this agreement or to the following:
Persons to contact in the case of emergency when parent or guardian cannot be reached:
Name of Public or Private School child attends, if any: