Child Medical Information
Here at Livingston Forge, it is our top priority to ensure your child remains safe and unharmed while in our care. The information below will aid us in properly accommodating to your child's personal needs. Please fill out one form for each child.
First name
Last name
Does your child have any allergies? If none, please state "none."
Does your child have any mental disabilities we need to be aware of?
Does your child have any physcial disabilities we need to be aware of?
When was your child's last T Dap Vaccination? ( Tetanus-Diphtheria-Pertussis)
Please provide any additional information you feel we need to know.
Parent/Gaurdian Name
Phone Number
Address
Email
Who is the emergency contact?
Phone Number
Email
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