REGISTRATION FORM
A Registration Form per child must be submitted prior to an interview with Little Explorers Adventure Care. L.E.A.C is located in Rockland and operates from Monday-Friday 7:30am-4:30pm.
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Today's date
-
Month
-
Day
Year
Date
Your name
First Name
Last Name
Your email address
example@example.com
Your cellphone number
Please enter a valid phone number.
Child's Date Of Birth
Little Explorers Adventure Care ONLY accepts children 1-4 years old
Child's gender
FEMALE
MALE
What days of care do you need?
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
What hours of care do you need?
L.E.A.C only operates from 7:30am-4:30pm
Do you have backup care in case daycare is close due to holidays/sickness?
YES
NO
Does your child nap?
Yes, one nap
Yes, two naps
No
Does your child have any food allergies? If yes, which ones?
(Eggs, dairy, nuts, ext.)
Does your child have any food restrictions? If yes, which ones?
(Dairy, pork, etc.)
How would you describe your child?
When do you need care by?
-
Month
-
Day
Year
Date
THANK YOU
I appreciate your time for filing out the registration form. I will get back to you promptly.
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