MaMaTice Drop in Childcare Form

MaMaTice Drop in Childcare Form

Happy Kids Happy Parents
How did you hear about us?*
Student Name*

First NameLast Name
Birthday
Age*
Student age
List some things your child likes to do.*
Rate your child’s behavior.*

Great listens with little directionSomewhat listens and follow directionsNeeds lots of guidance but still listensDoes not listen
Student Name*

First NameLast Name
Birthday
Age*
Student age
List some things your child likes to do.*
Rate your child’s behavior.*

Great listens with little directionSomewhat listens and follow directionsNeeds lots of guidance but still listensDoes not listen
Other details or questions *
Be specific about all children needing care. Include any special care treatment needed.
Allergies: please specify allergies for each student listed*
List any known allergies child has if none type N/A
Day of care*

1 Day M-FSatSun3 daysOther
Please explain/list days and times needed*
Please list other kids here who need care.*
Name,age,any known allergies
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number *
Email*
example@example.com
Place of Employment*
Work Number
Parent 2

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Emergency Contact Name and Number:*
List other names and numbers of people allowed to pick up your children.*
*Transportation and Media Release Agreement*

This agreement is made between MamaTice Child Care and the parent name and signature below.

1. *Transportation*: The MaMaTice Childcare is authorized to transport the child to and from hospital in case of emergency, field trips, grocery stores, and other activities related to the child care program.

2. *Media Release*: The Child Care is granted permission to use the child's image, name, and likeness for promotional and marketing purposes only, including but not limited to social media, flyers, and brochures.

3. *Terms*:

- The Child Care will ensure the child's safety and well-being during transportation and activities.

- The Parent will provide accurate and up-to-date contact information and emergency details.

- This agreement remains in effect until revoked in writing by either party.

**All Drop in Care requires 24 to 48 hour notice.

*All Payments must be made once this form is complete to confirm spot.

*No refunds(if no fault of MaMaTice)partial payment will be applied towards next childcare service if canceledwithin 24 hours of Care
A link will be sent to your phone shortly on how to complete payment information and other details.

Thank you!

Once you complete payment this will secure your child's spot.
First and Last Name*
This will act as signature
Date

MonthDayYear
Date
Signature*

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