Student Information Form
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1
21803 14th Avenue NE
CROSSROADS
Calgary, AB
COMMUNITY
PRESCHOOL
Canada
Phone: (403)277-2168
Email:
crossroadspreschool.ca
STUDENT INFORMATION FORM
CLASS:
3A
Child’s Name:
)
Surname
Given Name (s
Current Age:
Birth Date:
Day / Month / Year
Address:
City:
Postal Code:
Email Address:
Phone Number (home):
Phone Number (cell):
Languages Spoken at Home:
FAMILY INFORMATION
Siblings:
Brothers
Sisters
Mother’s Name:
Address:
Phone #:
Employer:
Address:
Phone #:
Father’s Name
Address:
Phone #:
Employer:
Address:
Phone #:
EMERGENCY CONTACT
EMERGENCY CONTACT
Name:
Name:
Address:
Address:
Phone Number:
Phone Number:
Relationship with Child:
Relationship with the Child:
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Parent category: Business