3 minutes
Any parent who is willing and interested to join his/her child in Day Care is eligible to fill out the Day-care registration form.
Child's Legal Name
Birth Date
Preferred Name
Gender
Address
City
State
Country
Zipcode
Home Phone Number
Parent / Guardian Information
Father/Mother's Name
Address
Occupation
Name of Employer
Work Phone Number
Work Hours
Work Address
Parent/Guardian with legal custody
Parents are: (please check one)
Child Pickup Information
Name
Age
Relationship
Signature
Signed Date