CLASSROOM ROSTER
STATEMENT OF PERMISSION
___ I DO NOT wish my name and my child's name to appear on the Class Parent/Child Roster
___ Yes, I DO wish my name and my child's name to appear on the Class Parent/Child Roster. I wish it to appear as follows:
| CHILD'S NAME ____________________________________________________________________ | |
| PARENT'S/GUARDIAN'S NAME_______________________________________________________ | |
| ADDRESS__________________________________________________________________________ | |
| PHONE NUMBER____________________________________________________________________ |
In accordance with State Licensing Rules and Regulations governing Child Care Centers, we must have written permission from the parents/guardians to have the child and parents'/guardians' names placed on the Class Rosters.
|
Signature |
Date |
Please complete this form and return it with your registration. A tentative roster will be sent to you during the summer.
(02/06)