BCC Learning Center app BCC Learning Center app Parent/Guardian Contact Information Question Title * 1. Parent/Guardian Contact Information Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Child 1 Question Title * 2. Child 1 Full Name Grade Age BDAY (mm/dd/year) Child 2 Question Title * 3. Child 2 Full Name Grade Age BDAY (mm/dd/year) Child 3 Question Title * 4. Child 3 Full Name Grade Age BDAY (mm/dd/year) Child 4 Question Title * 5. Child 4 Full Name Grade Age BDAY (mm/dd/year) Does your child or children suffer from any LIFE THREATENING allergies? (food related, bee stings, etc) Question Title * 6. Does your child or children suffer from any LIFE THREATENING allergies? (food related, bee stings, etc) YES NO If you answered YES please explain. Has your child been tested for OR diagnosed with any behavioral issues? (ADD, ADHD, etc). Question Title * 7. Has your child been tested for OR diagnosed with any behavioral issues? (ADD, ADHD, etc). YES NO If you answered YES please explain. Who is your Emergency Contact? Question Title * 8. Who is your Emergency Contact? Name Phone Number Who, besides the parent/guardian, has permission to pick up your child/children? Question Title * 9. Who, besides the parent/guardian, has permission to pick up your child/children? Name Phone Number Who is your Emergency Contact? Question Title * 10. Who is your Emergency Contact? Name Phone Number Done
