Day Care Registration

Day Care Registration

Submitting this application DOES NOT guarantee a spot for your child.

Parent's Information
Parent's/Guardian's name *
Phone number *
Place of work
Email address *
2nd Parent's Information
Parent's/Guardian's name
Phone number
Place of work
Email address
example@example.com
1st Child's Information
First name *
Last name *
Street address *
Street address line 2
City *
State *
Zip code *
Date of Birth *

Month Day Year
Date
Male or female? *

Female Male
2nd Child's Information
First name
Last name
Street address
Street address line 2
City
State
Zip code
Date of Birth

Month Day Year
Date
Male or female?

Female Male
3rd Child's Information
First name
Last name
Street address
Street address line 2
City
State
Zip code
Date of Birth

Month Day Year
Date
Male or female?

Female Male
Requested Start Date

Month Day Year
Date
Days of the week required

Monday Tuesday Wednesday Thursday Friday
Day Care hours are currently 7:30am to 5pm due to Covid-19. Our regular hours are 7am to 5pm. All children are charged for 5 days whether they attend or not. We do take children on Day Care subsidy. Children get 10 days of excused non-payment days.
Questions or Comments?
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