St. Mark's Lutheran Academy - General Information Form

General Information

Child's Name

Child's Birth Date

Parent Name(s)

This address will receive a confirmation email

Parent Phone Number(s)

Address

Emergency Contacts

Primary Emergency Contact Name

Primary Emergency Contact Relationship

Primary Emergency Contact Phone Number(s)

Primary Emergency Contact Email Address

Secondary Emergency Contact Name

Secondary Emergency Contact Relationship

Secondary Emergency Contact Phone Number(s)

Secondary Emergency Contact Email Address

Other individuals authorized to pick up child:

Medication Information

Does your child have any allergies? Please list any treatments you use for any allergies:

Does your child have any dietary restrictions?

Does your child currently take any medications?

Child Information

What is your child's favorite color?

What is your child's favorite animal?

What is your child's favorite game/toy?

Is your child frightened by anything specific?

Can we take photos of your child for family gift purposes?

Is there any other information that I need to know about your child?

Description

Thank you for showing interest in St. Mark's Lutheran Academy. If you have any questions, please feel free to contact us at academy@stmarksbg.org.