BRIGHT HORIZONS

PARENT/GUARDIAN INFORMATION FORM

There may be times phone numbers and addresses of families are requested by parents/
guardians so that children may have play dates outside of the center/school.

Please check the information that Bright Horizons MAY give to other parents/guardians enrolled
in the center/school upon request.

Childs Name: ________________________________________________________________

Parent/Guardian Name: _________________________________________________________

Parent/Guardian Home Phone Number

Parent/Guardian Work Phone Number

Parent/Guardian Cell Phone Number

Parent/Guardian Home Address

Parent/Guardian E-mail Address

Parent/Guardian Name: ___________________________________________________________

Parent/Guardian Home Phone Number

Parent/Guardian Work Phone Number

Parent/Guardian Cell Phone Number

Parent/Guardian Home Address

Parent/Guardian E-mail Address

Please do not give out any of the information listed above.

The information detailed above will be shared only with parents/guardians whose children are
currently enrolled in the center/school.

_______________________________________________ _______________________
(Parent/Guardians Signature) (Date)

Operations_Enrollment_US page 1 of 1
Reviewed 11/2011