📌Section 1: Child Information
Date of birth
👨👩👧👦Section 2: Parent/Guardian Information
Parent/Guardian Name (Primary Contact)
Relationship to Child
Phone Number
Email Address
Home Address
Secondary Emergency Contact Name
Phone Number (Emergency Contact)
🕒Section 3: After-Care Program Details
Days Attending After-Care
Authorised Pickup Persons (Other than parents)
(List names and phone numbers)
💊Section 4: Medical & Additional Information
Allergies or Medical Conditions
Medications Taken During After-Care
Any Special Needs or Accommodations
📄 Section 5: Consent & Agreement
I agree to follow all rules and payment policies of the After-Care Program.
Signature of Parent/Guardian (Type Full Name)
Date of Submission
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