ChildCare Registration

ChildCare Registration

MY KIDZONE CHILDCARE (INVITE ONLY)
CONGRATULATIONS WELCOME TO OUR FAMILY....YOU'VE MADE IT OFF THE WAITLIST!!!!

THIS FORM IS PER CHILD!!! All children are required to wear uniforms. They can be purchased at Fashion Era on Florida Blvd. Registration fee ($100) is due with submission of this form. Supply fee mentioned on waiting list form shall be paid within first 2 WEEKS of attendance.
Information of Child
Name

First NameLast Name
Birth Date

MonthDayYear
Parent Requesting Start Date
Admission Date/ Start Date (Administration Use Only)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender

FemaleMale
Hours of child care required (school hours are 5:30 am to 6:00 pm)

Full dayHalf-day morningHalf-day afternoonOther
Days of the week required

MondayTuesdayWednesdayThursdayFriday
Do you require before or after school care?

Before schoolAfter school
Information of Parent
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Place of Work
Emergency Contact 1
In the event of an emergency, please contact:
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Place of Work
Other people authorized to pick up child from school
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Place of Work
Medical Information
Doctor's Name

First NameLast Name
Doctor's Phone Number
Please enter a valid phone number.
Dentist's Name

First NameLast Name
Dentist's Phone Number
Please enter a valid phone number.
Preferred hospital
Insurance/health coverage
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns.
My Kidzone Childcare photography & video release. Pictures may be used in center and/or social media platforms.

YES, I do authorize my kidzone chidcare to photograph/videgraph my childNO, I do not authorize my kidzone chidcare to photograph/videograph my childYES, I authorize photographs/videography but I DO NOT AUTHORIZE SOCIAL MEDIA PLATFORMS
PARENT SIGNATURE

Clear
DATE REGISTRATION COMPLETE

My Products

Registration Fee per child

$100.00

Supply Feetwice yearly supply fee covers basic essentials for child's learning day to day

$50.00 Quantity

Spirit Shirt (We Wear on Fridays)

$12.00 QuantitySize

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Parent ID*

Cancelof
Student Birth Certificate

Cancelof
Student Shot Record

i
Cancelof
Should be Empty:

ChildCare Registration

CONGRATULATIONS WELCOME TO OUR FAMILY....YOU'VE MADE IT OFF THE WAITLIST!!!!

Information of Child

Information of Parent

Medical Information