Free Day Care Registration Form Template

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

        Email

          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:

                                Form Templates @ Template.net

                                Thank you for your submission!

                                We appreciate you taking the time to submit.

                                Create free forms at Template.net