One-Line Application Child's Name Social Security Number Sex male female Birthdate Address Home Phone Email Father's Name Occupation Work Phone Mother's Name Occupation Work Phone Ethnic/Cultural Background Other American Indian Asian/Pacific Black Hispanic White Languages Spoken at Home Persons with Whom the Child Lives parents, mother, father, step-parent, grandparent, siblings, aunt, uncle, other--Specify Emergency Contact #1 Name Phone Relation Emergency Contact #2 Name Phone Relation (Emergency contacts must be different from parents.) Food Allergies Restricted Foods Special Health Conditions Doctor's Name Phone Preferred Session AM PM Carpooling with