By filling this out, you certify you’re a parent / legal guardian of the child.

All fields required.

About You
Other Caretakers List all person(s) designated to pick up your child. Place each name on a new line, with preferred contact info, and then relationship to child, like so:

Lewis Carroll,, uncle
J.K. Rowling, 415-867-5309, aunt
Theodor Seuss, 617-903-5768, grandfather