1. Child's Name

2. Address

3. Teacher 4. Grade Pre-K Kindergarten

5. Session AM PM

6. Home Telephone #

7. Mother's Work # 8. Father's Work #

9. Name of person to call in an Emergency 10. Telephone#

11. Emergency Contact (at least 2 telephone numbers) 12.

Transportation information

14. Transportation to School: Bus # 1 2 3 4 56 15. Bus Tag Color Blue Green Red Yellow Tan 16. Bus Stop:

Transportation from School: Any of the following persons has my permission to pick up my child from school or bus stop:

17. Name 18. Telephone #

19. Name 20. Telephone #

21. Name 22. Telephone #

Baby-sitter/Daycare Provider Information

23. Name of Baby-sitter/Center/Daycare Provider:

24. Address: 25. Telephone #

26. Name of Person Submitting Form

27. E-mail Address

Note: Please be sure to notify the school if any changes occur in the above information.