BCC Learning Center app BCC Learning Center app Question Title * 1. Parent/Guardian Contact Information Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 2. Child 1 Full Name Grade Age BDAY (mm/dd/year) Question Title * 3. Child 2 Full Name Grade Age BDAY (mm/dd/year) Question Title * 4. Child 3 Full Name Grade Age BDAY (mm/dd/year) Question Title * 5. Child 4 Full Name Grade Age BDAY (mm/dd/year) 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. 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. Question Title * 8. Who is your Emergency Contact? Name Phone Number Question Title * 9. Who, besides the parent/guardian, has permission to pick up your child/children? Name Phone Number Question Title * 10. Who is your Emergency Contact? Name Phone Number Done
