Free Daycare Application Form Template
Daycare Application Form
Please fill out the following information to complete your application.
Child Information
Name
Date of Birth
Gender
-
Male
-
Female
Address
Parent/Guardian Information
Name
Relationship to Child
Phone number
Employer
Authorized Pickup Persons
Name
Relationship to Child
Phone number
Health Information
Pediatrician's Name
Phone number
Known Allergies
Medical Conditions
Medications Taken Regularly
Agreement and Signature
I certify that the information provided is accurate to the best of my knowledge and agree to follow the daycare’s policies and procedures as outlined in the Parent Handbook. I understand that this application does not guarantee enrollment, and that a spot will only be confirmed upon further communication from the daycare.
Date:
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