Common use of Custodial Statement Clause in Contracts

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Additional Emergency Contacts (also able to pick up child):

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Additional Emergency Contacts (also able to pick up child):

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Name: Name: Additional Emergency Contacts (also able to pick up child):

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Childs living arrangements: Please tick appropriate box Mother only Father only Both parents together Other Additional Emergency Contacts (also able to pick up child):

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Additional Emergency Contacts (who are also able to pick up child):your child (do not include parents). Please let the persons named know that they will be expected to pick up your child in case of an emergency when we can’t get hold of parents/caregivers.

Custodial Statement. Are there any custodial arrangements concerning your child?  Yes  No If YES, please give details of any custodial arrangements or court orders (a orders. A copy of any court order is required. Names of any person(s) Person/s who cannot pick up your child: Name: Name: Name: Name: Additional Emergency Contacts (also able to pick up child)::

Custodial Statement. Are there any custodial arrangements concerning your child? □ Yes □ No If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Additional Emergency Contacts (also able to pick up child):)

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Any changes to this form must be signed and dated by the parent/guardian. Country Village Preschool Enrolment form Person/s who cannot pick up your child: Name: Name: Name: Name: Additional Emergency Contacts (also able to pick up child):

Custodial Statement. Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Person/s who cannot pick up your child: Name: Name: Name: Name: Any changes to this form must be signed and dated by the parent/guardian. Additional Emergency Contacts (also able to pick up child):