Codee Daycare
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Child Information
First Name
*
Last Name
*
Preferred Name
Birthday (YY/MM/DD)
*
Gender
*
Address
*
City
*
Province
*
Postal Code
*
Parent/Guardian
First Name
*
Last Name
*
Relation to Child
*
Address
*
City
*
Province
*
Postal Code
*
Phone
*
Work Phone
*
Email
*
Authorization
I authorize the following person to pick up my child and to be contacted for emergency.
First Name
*
Last Name
*
Relation to Child
*
Address
*
City
*
Province
*
Postal Code
*
Phone
*
Work Phone
*
Email
*
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