Change of Information Form

Notification of Changes in Child’s Records
If a Change occurs that should be noted on your child’s records, please complete this form and bring it to the Director’s office as soon as possible. It is imperative that we keep all our records updated so that you can be contacted in case of emergency.
Child's Name*
First Last
Please make the following changes to my child’s records:
Change of Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Change of home telephone number:
Change of father’s work telephone number:
Change of father’s cell phone number:
Change of father’s email address:
Change of mother’s work telephone number:
Change of mother’s cell phone number:
Change of mother’s email address:
Change or addition to persons who child may be released (Name, Address & Tel. #)
Change in marital status or living arrangements:
E-Signature*
Today's Date*
Month
Day
Year

Registration

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