Actor Contact Information
Name_____________________________________
Grade___________
Does your child have any medical conditions that we should be aware of? (Seizures, chronic headaches, psychological, etc.)____________________________________________________
Does your child have any allergies that we should be aware of? (Food, medication, insect bites, etc)______________________________________________________________________________
Home phone (______)____________________________________________
1stContact Name_____________________________________________ Work:_(_____)_____________
2nd Contact Name_____________________________________________Work: (_____)______________
Email:_________________________________________________________________________________
Emergency Contact:__________________________________________ Phone(_____)________________
Doctor_________________________________________________________ Phone(_____)____________
Parents Signature_____________________________________________Date:________
Proudly powered by Weebly
Name_____________________________________
Grade___________
Does your child have any medical conditions that we should be aware of? (Seizures, chronic headaches, psychological, etc.)____________________________________________________
Does your child have any allergies that we should be aware of? (Food, medication, insect bites, etc)______________________________________________________________________________
Home phone (______)____________________________________________
1stContact Name_____________________________________________ Work:_(_____)_____________
2nd Contact Name_____________________________________________Work: (_____)______________
Email:_________________________________________________________________________________
Emergency Contact:__________________________________________ Phone(_____)________________
Doctor_________________________________________________________ Phone(_____)____________
Parents Signature_____________________________________________Date:________
Proudly powered by Weebly