Childcare Center Registration Form
Childcare Center Registration Form
Please fill out this form completely to register your child for our childcare services.
Child's Information
Name
Date of Birth
Gender
-
Male
-
Female
Parent/Guardian Information
Name
Relationship to Child
Phone number
Emergency Contact Information
Name
Phone number
Relationship to Child
Medical Information
Allergies (if any)
Emergency Medical Conditions
Preferred Physician
Physician Phone number
Authorized Pick-Up Information
Name
Phone number
Terms and Conditions
By signing this form, I consent to my child’s participation in the childcare services and understand the terms of service provided by the childcare center.
Name:
Date:
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