YWCA HOMEWOOD-BRUSHTON YWCA PROPEL BRADDOCK HILLS SCHOOLEmergency Contact Parental Consent/Enrollment Agreement • April 12th, 2021
Emergency Contact Parental Consent/Enrollment Agreement Child’s Information Child’s name Nickname? Birthdate Child’s home address City State Zip MALE □ FEMALE □ Primary language? Check box if foster child □ Family Information Parent/guardian/sponsor Relationship to child Home phone Cell phone Home address if different from above Employer Employer Address Work Phone Other parent/guardian/sponsor Relationship to child Home phone Cell phone Home address if different from above Employer Employer Address Work Phone Child Emergency Contact and Person(s) to whom child may be released Information (do not include parents/guardians/sponsors) Please notify the center if an Emergency Release Contact will pick up your child on a given day.[For the safety of your child, we request that all authorized pick up persons with whom staff is not familiar provide a photo ID at the time of pick up.] Person #1 Relationship to child Telephone number when child is in care Home address City State Zip Person #2 R
WCA HOMEWOOD-BRUSHTONEmergency Contact Parental Consent/Enrollment Agreement • May 31st, 2020
Child Emergency Contact and Person(s) to whom child may be released Information (do not include parents/guardians/sponsors)
