Daycare Admission Form

Daycare Admission Form

Please fill out this form to apply for your child's admission to our daycare.

Child’s Information

Name

    Date of Birth

      Gender

        • Male

        • Female

        Address

          Parent/Guardian Information

          Name

            Relationship to Child

              Phone number

                Alternative Phone Number

                  Medical Information

                  Allergies or Special Needs (if any):

                    Doctor’s Name:

                      Doctor’s Phone Number

                        Signature

                        Name:

                        Date:

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