The Learning Playhouse Registration Forms Family Name _______________ Home phone # ____________ Home address ______________________________________ Child’s name _____________age____ birthday_____________ Health card # _______________ Allergies _______________ Child’s name _____________age____ birthday_____________ Health card # _______________ Allergies _______________ Child’s name _____________age____ birthday_____________ Health card # _______________ Allergies _______________ Mother’s name_________ Employer______________________ Work #__________________ cell # ___________________ Father’s name_________ Employer______________________ Work # _________________ cell # ____________________ Emergency contact person _____________________________ Daytime # ________________ cell # ___________________ 2nd emergency contact person __________________________ Daytime # ________________ cell # ___________________ Name of persons allowed to pick up ______________________ _________________________________________________ Family Physician _______________ phone # ______________ Address _______________________ Date ____________ Parents Signature __________________ Parents Signature __________________