Pre-Registration Form

Summer Stem Camp or Traditional Childcare
Pre-Registration Form

Everyday Sunshine -Westlake Campus
Parent #1 Name*

First NameLast Name
Parent #2 Name

First NameLast Name
Child's Name*

First NameMiddle NameLast Name
Child's Birth Date*

MonthDayYear
Child's Gender*
Child's Name

First NameMiddle NameLast Name
Child's Birth Date

MonthDayYear
Child's Gender
Child's Name

First NameMiddle NameLast Name
Child's Birth Date

MonthDayYear
Child's Gender
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary E-mail*
example@example.com
Secondary E-mail
(optional)
Preferred Start Date
Parent #1 Primary Phone Number
Format: (000) 000-0000.
Parent #2 Primary Phone Number
Format: (000) 000-0000.
Exceptional Childcare Needs/ Allergies
Additional Comments
If not full-time, please indicate preferred schedule.
Should be Empty: