| EMERGENCY INFORMATION |
| ALTERNATE PICK-UP-DROP-OFF INFORMATION (copy of driver's License required to pick-up child) Name:______________________________Relation to child_________________________ Home#_____________________Cell______________________Other__________________ Automobile Make:______________Model__________Color__________Lic #____________ Alternate Name:______________________________Relation to child__________________ Home:__________________Cell________________Other____________________________ Automobile Make:_______________Model___________Color_________Lic_____________ EMERGENCY CONTACT INFORMATION Name:______________________________Relation to child_________________________ Home#_____________________Cell______________________Other__________________ Automobile Make:______________Model__________Color__________Lic #____________ Alternate Name:______________________________Relation to child__________________ Home:__________________Cell________________Other____________________________ Automobile Make:_______________Model___________Color_________Lic_____________ Parent Signature_______________________________________Date_____________________ |