Dreamy Eyes Childcare
REGISTRATION FORM
Parent Details
*
Mother's Legal Name
Father's Legal Name
Gaurdian details (if applicable)
*
Legal Name
Relationship to the Child
Current Address
*
Address, city, state, postal code
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
Child Details
*
Legal Name
Age
Allergies , Medications , and Special Needs (please provide details)
*
Days Required
*
Please Select
Monday to Friday
Monday,Wednesday,Friday
Tuesday, Thursday
Expected Start Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Living Arrangement
*
Please Select
Both Parents
Mother
Father
Gaurdian
Number of Siblings
*
Please Select
None
1
2
3
4 or More
How did you hear about Dreamy Eyes Childcare?
*
Please Select
Referral
Google
Facebook
Instagram
Others
Has the child attended daycare before?
*
Please Select
Yes
No
Submit
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