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CHILD SIGN UP FORM
Your Child's Info
Child's Name   Home Phone
Birth Date / / Languages spoken
Gender Male / Female   School
Address   Grade

City

 

Age

Postal Code

 

 

 
         
Mother's Info Father's Info  
Name   Name
Cell
  Cell
Occupation
(optional)
  Occupation
(optional)
email   email
Best way to reach us: Home Phone / Cell Phone / Work Phone / E-mail
Parent's Status Married / Divorced - Child living with:
 
Medical Information

 

Emergency Contact Name

(other than parent)

Relationship
Emergency Contact number 1
Emergency Contact number 2
What are your child's special needs?
Please list any allergies or medical conditions that we should be aware of:

   
 

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Friendship Circle of Miami Beach and North Dade
4200 Biscayne Blvd.
Miami , FL 33137-2573
305-330-5653
About Us