Parent / Guardian Permission to Observe

Phone

Center *

Month / Year *

Child's Name *

Date of Birth *

Parent / Guardian Name *

Parent / Guardian Email *

Phone Number *

Comments / Concerns

All services are provided without regard to race, age, color, religion, sex, disability, national origin, ancestry, or status as a veteran.

CAPE is an equal opportunity employer and does not discriminate on the basis of race, color, national origin, sex, age or disability.