Father's Information

• Toilet TrainingYes - My child is completely toilet trained.No - My child is not completely toilet trained.
• Pertinent medical history or special medical needs:
  
• Physical or emotional needs:
  
• Precautions for diet, medications, or activities (include allergies):
  

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  Child’s Physician or Medical Provider

• Name
  Address
  City	State MS AL LA FL AK AS AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY ME MD MA MI MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY		Zip
  Phone		Chart #

Photography

Field Trips

I do give permission for my child to participate on field trips and special activities at Little People’s Christian Academy, Inc. I understand that I will receive additional information before each trip or activity and will make arrangements with the center if I do not wish for my child to participate.

Emergency Medical Treatment