Child Admission Agreement & Health AssessmentChild Admission Agreement • July 27th, 2009
Contract Type FiledJuly 27th, 2009Name Relationship to Child Address Phone # G Check if there are no emergency contacts available, other than parents.G Check if there are no persons authorized to pick up the child, other than parents. Out of Area/State Contact Name(If available) Relationship to Child Address Phone # G Check if there are no out of area/state contacts available.