Day Care Registration Form
Day Care Registration Form
Please complete all fields below to register your child for our day care program.
Child's Name
Date of Birth
Parent/Guardian Name
Phone Number
Home Address
Emergency Contact Number
Dietary Restrictions
Allergies
Days of Attendance
-
Monday
-
Tuesday
-
Wednesday
-
Thursday
-
Friday
Authorized Pickup Persons
Name
Phone number
Name
Phone number
Additional Information
Parent/Guardian Name:
Date:
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