Free Childcare Center Registration Form Template

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

              Email

                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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