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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..

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The man who will use his skill and constructive imagination to see how much he can give for a dollar, instead of how little he can give for a dollar, is bound to succeed. | Henry Ford