Daycare & Preschool Enrollment Form
Child's Information
Child's Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Home Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
*
Female
Male
Attendance Information
Expected Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Attendance Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
From
*
Hour Minutes
AM
PM
AM/PM Option
To
*
Hour Minutes
AM
PM
AM/PM Option
Additional Information regarding Attendance
Patents/Guardian & Emergency Contact Information
Name
*
First Name
Last Name
Email
*
example@example.com
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
*
Mother, Father, etc
Work Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Same with the child
Different Address
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name
*
First Name
Last Name
Email
*
example@example.com
Relationship
*
Mother, Father, etc.
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Same with the child
Different Address
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Another Person Authorize To Collect Child
First Name
Last Name
Relationship
Home Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Another Person Authorize To Collect Child
First Name
Last Name
Relationship
Home Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does the child has any allergy?
*
We provide breakfast daily.
Kindly Note
For admittance of any child, you will be required to bring a health paper and a passport-size photo.
A copy of the child's birth certificate can be uploaded below.
We are open from 6:30 am to 5:30 pm Monday-Friday.
Weekly Cost is $100.00.
Upload Copy of Child's Birth Certificate
LOCATION
WORTHING CHRIST CHURCH 1 246 268 8788
Submit
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