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Student’s Name

Grade

Address

Date of Birth

Phone

Doctor’s Info

Emergency Contact Name

Emergency Contact Phone

List any allergies the child may have

Food Prep Preference

Self School

Toilet Trained

Yes No

Full Name

Address

Marital Status

Married Single

NRC #

Occupation

Work Phone

Employer

Relationship

Grade

Baby Class (9 months–2 yrs) Middle Class (2–4 yrs) Reception (4–6 yrs)