Registrationemergency

CHILD CARE REGISTRATION AND EMERGENCY INFORMATION _________________________________________________________________ NAME OF CHILD CARE PROGRAM ____________________ LICENSE NUMBER TO THE PARENT OR GUARDIAN: This form must be completed for each of your children who will be enrolled in the program, and must be updated whenever information changes.. Name: Name: Relationship: Relationship: Address: Address: Phone number: Phone number: (7) CHILD CARE REGISTRATION AND EMERGENCY INFORMATION NON-EMERGENCY ALTERNATE PICK-UP PERSON/S Continued Name: Name: Relationship: Relationship: Address: Address: Phone number: Phone number: NOTE TO PARENT/S or GUARDIAN/S: The licensing authority for this program is the Bureau of Licensing and Certification, Child Care Licensing Unit..