Campbell Recreation Pre-School
Child Information Form
Gender Birthdate (MM/DD/YY) Home/Primary Phone Number
Home Street Address City Zipcode

Does the child speak Engish? If no, what language is spoken?

  
 
  




  
(Other than parents/guardian)
 
Contact Name Relationship Phone Number
Please list any additional people authorized to pick up your child other than those already listed on this form:
Name Relationship Name Relationship
   
Contact Name Relationship Phone Number

Mobile Phone Number
Work Phone Number
Email Address

Mobile Phone Number
Work Phone Number
Email Address
Your name, phone number, and email address will be on the class contact list for your child’s class (unless you opt out). Please
check one phone number and one email above for the class contact list.
spoken written
Choose Gender
Yes
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome