BCC Learning Center app

Parent/Guardian Contact Information

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* 1. Parent/Guardian Contact Information

Child 1

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* 2. Child 1

Child 2

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* 3. Child 2

Child 3

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* 4. Child 3

Child 4

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* 5. Child 4

Does your child or children suffer from any LIFE THREATENING allergies? (food related, bee stings, etc)

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* 6. Does your child or children suffer from any LIFE THREATENING allergies? (food related, bee stings, etc)

Has your child been tested for OR diagnosed with any behavioral issues? (ADD, ADHD, etc).

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* 7. Has your child been tested for OR diagnosed with any behavioral issues? (ADD, ADHD, etc).

Who is your Emergency Contact?

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* 8. Who is your Emergency Contact?

Who, besides the parent/guardian, has permission to pick up your child/children?

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* 9. Who, besides the parent/guardian, has permission to pick up your child/children?

Who is your Emergency Contact?

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* 10. Who is your Emergency Contact?

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