ANYONE I understand that child will not be released not on the my to above list. Parent Signature Date Any person that the teacher has not- met before or does not know A PICTURE IDENTIFICATION (such as a driver's NEED TO_SHOW will license) before the child will be released. MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES SECTION FOR CHILD CARE REGULATION CHILD CARE ENROLLMENT FORM FOR LICENSE-EXEMPT FACILITIES FACILITY/PROVIDER NAME ADMISSION DATE DISCHARGE DATE HILLTOP PRESCHOOL NAME GENDER BIRTHDATE CHILD’S ADDRESS (STREET, CITY, STATE, ZIP CODE) IDENTIFYING INFORMATION NAME HOME TELEPHONE NUMBER MOTHER’S/GUARDIAN’S ADDRESS (STREET, CITY, STATE, ZIP CODE) OR CHECK IF SAME AS ABOVE CELL PHONE NUMBER E-MAIL ADDRESS EMPLOYER OR SCHOOL ATTEND WORK/SCHOOL SCHEDULE
I understand that my child will not be released to ANYONE not on the above list. Parent Signature Date Any person that the teacher has not- met before or does not know will NEED TO_SHOW A PICTURE IDENTIFICATION (such as a driver's license) before the child will be released. MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES SECTION FOR CHILD CARE REGULATION CHILD CARE ENROLLMENT FORM FOR LICENSE-EXEMPT FACILITIES FACILITY/PROVIDER NAME HILLTOP PRESCHOOL ADMISSION DATE DISCHARGE DATE CHILD’S NAME GENDER BIRTHDATE ADDRESS (STREET, CITY, STATE, ZIP CODE) IDENTIFYING INFORMATION MOTHER’S/GUARDIAN’S NAME HOME TELEPHONE NUMBER ADDRESS (STREET, CITY, STATE, ZIP CODE) OR CHECK IF SAME AS ABOVE CELL PHONE NUMBER E-MAIL ADDRESS EMPLOYER OR SCHOOL ATTEND WORK/SCHOOL SCHEDULE
Enrollment-forms-2018-fillable-1.docx