Child Care Registration

Child Care Registration

PLAY.ISH LLC Onsite Event Childcare
Event Date*

MonthDayYear
Date
Child's Information
Name*

First NameLast Name
MaleFemaleOther
Age?*
Parent Information
Name*

First NameLast Name
Primary Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email address*
example@example.com
Parent Information
Name

First NameLast Name
Primary phone number
Email address
OTHER persons authorized to pick up your child during the duration of this event.
Name

First NameLast Name
Name

First NameLast Name
Medical information
Please list any of the following: Allergies, food allergies, or chronic health concerns?*
Tell us about your child: Any standout likes or dislikes?, Sensitivity to noise or brightness? *
Anything else we should know?*
Please upload 1 clear picture of child(ren) and 1 clear picture of designated parent(s)*

Cancelof
Thank you for taking the time to fill in our registration form!
Should be Empty: