Little Lions Learning Center Registration Packet

Guardian Information

Please note that the individual listed here will be permitted to sign child out
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Employer
Driver License #

Emergency Contact 1
In the event of an emergency, please contact:
Name

First NameLast Name
Relationship
Driver License #
Phone Number
Please enter a valid phone number.
Emergency Contact 2
In the event of an emergency, please contact:
Name

First NameLast Name
Relationship
Driver License #
Phone Number
Please enter a valid phone number.
Emergency Contact 3
In the event of an emergency, please contact:
Name

First NameLast Name
Relationship
Driver License #
Phone Number
Please enter a valid phone number.
I understand that any of the above named individuals are authorized to pick my child up from daycare*

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Date

MonthDayYear
Date

Medical Information
Childs Name

First NameLast Name
Insurance Policy and Number
Family Physician
Physician Phone number
Please enter a valid phone number.
Dentist
Dentist's Phone Number
Please enter a valid phone number.
Please select one of the following

I give approval for listed child above to receive necessary emergency medical treatment while attending Little Lions Learning CenterI DO NOT give approval for listed child above to receive necessary emergency medical treatment while attending Little Lions Learning Center
Please sign agreeing to your selection above

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Does your child have any food or environmental allergies? If yes, please list
Does your child have a medical condition we should be aware of? If yes, please explain
Please note that Little Lions Learning Center DOES NOT administer medication of any kind

Media/Publications Release Parental Consent Form
Please read and select one of the following

I give permission for the Little Lions Learning Center to photograph, film, record and/or interview my child while participating in program activities with other children and with staff on duty as part of the program design. I also give permission for Little Lions Learning Center to release these photographs or recordings for publication purposes. I agree to hold Little Lions Learning Center and/or its representative harmless from any liability, legal or financial, which may arise from the rise of anything that may be said or done during said recordings, photography, and/ or interviews or from the use of any photography/negatives or correspondence submitted. Furthermore, I authorize the unlimited use of voice or image as recorded/reproduced, and waive the rights to inspect or approve the product or its use.I DO NOT give permission for Little Lions Learning Center to photograph, record, and/or interview my child while participating in program activities with other children and with staff on duty as part of the program design. I also DO NOT give permission for Little Lions Learning Center to release the photos/recordings for publication purposes.
Please sign agreeing to your selection above

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Date

MonthDayYear
Date

Animal and Fish Waiver
Childs Name

First NameLast Name
State regulations require us to have permission forms on file for each child regarding live animals in the classroom. Please choose one of the following below and sign.

Yes, I give my child permission to be in the presence of animals or fish that may be in the classroom.No, I DO NOT give my child permission to be in the presence of animals or fish that may be in the classroom.
Please sign to agree to the above terms*

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How did you hear about us?*

Social MediaGoogle SearchRecommended by Friend or FamilyMovie Theater AdOther
Please click the link below to view our handbook
LLLC Parent Handbook
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Little Lions Registration Form