SOULSHINE CO-WORKING AND CHILDCARE INTEREST FORM
TODAY'S DATE
*
-
Month
-
Day
Year
Date
WHICH SOULSHINE CO-WORKING AND CARE PLAN ARE YOU MOST INTERESTED IN ?
*
Daily
Weekly
Monthly
DO YOU HAVE A CHILD/CHILDREN CURRENTLY ENROLLED AT SOULSHINE SCHOOLS? If yes, please select the location:
*
Kirkwood
Decatur
East Atlanta
Not Applicable
WHEN WOULD YOU BE INTERESTED IN USING SOULSHINE CO-WORKING AND CHILD CARE?
*
-
Month
-
Day
Year
Date
WILL YOU HAVE A CHILD ENROLLED IN SOULSHINE CO-WOKRING AND CARE?
*
Yes
No
CHILD'S NAME
First Name
Last Name
CHILD'S AGE
CHILD'S DATE OF BIRTH or DUE DATE
-
Month
-
Day
Year
Date
ADDITIONAL CHILD'S NAME
First Name
Last Name
CHILD'S AGE
ADDITIONAL CHILD'S DATE OF BIRTH or DUE DATE
-
Month
-
Day
Year
Date
CHILD'S LEGAL GUARDIAN(S)
*
PARENT/GUARDIAN 1
PARENT/GUARDIAN 2
Both
Other
CHILD'S LIVING ARRANGEMENTS
*
PARENT/GUARDIAN 1
PARENT/GUARDIAN 2
Both
Other
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PARENT/GUARDIAN INFORMATION
(PLEASE NOTE THAT BOTH PARENTS MUST BE LISTED IF THEY HAVE CUSTODIAL RIGHTS)
CHILD'S HOME ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT/GUARDIAN 1: FULL NAME
*
First Name
Last Name
EMAIL ADDRESS
*
example@example.com
BEST CONTACT PHONE NUMBER
*
Please enter a valid phone number.
ALTERNATE CONTACT NUMBER
Please enter a valid phone number.
HOME ADDRESS (IF DIFFERENT FROM CHILD'S)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PLACE OF EMPLOYMENT
WORK EMAIL ADDRESS
example@example.com
WORK PHONE NUMBER
Please enter a valid phone number.
PARENT/GUARDIAN 2: FULL NAME
First Name
Last Name
HOME ADDRESS (IF DIFFERENT FROM CHILD'S)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
BEST CONTACT NUMBER
Please enter a valid phone number.
ALTERNATE CONTACT NUMBER
Please enter a valid phone number.
PLACE OF EMPLOYMENT
WORK EMAIL ADDRESS
example@example.com
WORK PHONE NUMBER
Please enter a valid phone number.
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