2017-2018 Pick up Info

                               2017-2018

    Trinity Lutheran Nursery School & Mothers’ Morning Out

 

Child’s Name_________________________________

Class_______________________________________

 

Emergency Contact information:

In the order of notification (include parents)

 

Name                       Relation                              Cell number

1.___________         __________________        ______________

2.___________         ___________________      ______________

3.___________        ____________________     _______________

4.___________        ___________________-     ________________

 

People Permitted to pick up your child from school:

Name                       Relation                                 Cell Number

1._____________       __________________        _________________

2._____________      ___________________        ________________

3._____________      ____________________       ________________

4.____________       _____________________      _________________

 

Allergies:__________________________________________________

Food Sensitivities___________________________________________

Does your child have asthma? yes or no  

Does your child have an inhaler ? Yes or no       Does your child have an epi pen? yes or no

 

e mail address________________________________________

 

Photo release:

Permission for my child,____________________________to have their picture taken for publication on the church’s web site, school’s facebook page and the local paper

___Yes, I give my permission

___No, I do not give my permission

Signed________________________________Date___________________   

 

 

          Please attach photo