Daycare Registration

We are thrilled to welcome your family to our daycare. Please use this form to provide important information about your child. If registering more than one child, please prepare a separate form for each.

Current Date*

Caregivers

First name of caregiver 1*

Last name of caregiver 1*

Email

Daytime phone number*

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Caregiver 1 Address*

Caregiver 1 Address Line 2*

If the child has a caregiver in another home, please provide name and contact details.

First name of caregiver 2*

Last name of caregiver 2*

Caregiver 2 Address*

Caregiver 2 Address Line 2*

About your child

Child First Name*

Child Last Name*

Date of Birth*

Gender*

Male Female Other

Are there siblings or other children in the home?*

Yes No

Does your child have allergies?*

1 2

Does your child have diet restrictions?*

1 2

Does your child take any medication?*

1 2

Is your child toilet trained?*

1 2

What activities does your child enjoy?*

When is bedtime, and the usual bedtime routine?*

What do we need to know about the health of your child?*

Anything else you would like to share about your child?*

Security and Safety

Who may pick up your child?*

Caregiver 1 Caregiver 2

Please understand that we take the safety of our children very seriously. No one may collect your child without being authorized by you, and showing ID. Please contact us if you wish to make other pick up arrangements.

Are there any custody issues regarding access?*

Fees and Payment

Our fees are $000.00 per calendar month. Payment is due in advance, before the last day of each month. There are no partial refunds for withdrawing your child mid-month.

We reserve the right to dismissing your child from our daycare program for any of the following reasons:

unpaid fees
violence towards staff or other children

Please sign below to indicate that you have read, understand, and agree to these terms.

Signature