K3 Learning Center Parent Inquiry Form
Serving infants to age 4 in a safe, nurturing, and learning-focused environment.
Please complete this form so we can better understand your child’s needs and ensure the best care possible.
SECTION 1: Parent / Guardian Information
Full Name
*
First Name
Middle Name
Last Name
Relationship to Child
*
Primary Phone
*
Secondary Phone
Email
*
example@example.com
Section 2: Child’s Information
Full Name
*
First Name
Middle Name
Last Name
Nickname (if any)
Date of Birth
*
-
Month
-
Day
Year
Date
Age Group
*
Infant (6 weeks–12 months)
Toddler (1–2 years)
Preschool (3–4 years)
Any siblings enrolled at K3?
*
Yes
No
Section 3 – Daily Care Details
Child’s typical daily routine
Comfort items your child uses (blanket, toy, pacifier, etc.)
Food preferences or restrictions
Section 4: Medical & Safety Information
Allergies (food, medication, environmental)
Medical conditions or concerns
Medications your child may need during care
Physician’s Name
Physician’s Phone
Section 5: Special Needs & Developmental Support
While K3 Learning Center is not a specialized facility for children with significant special needs, we want to understand your child’s developmental stage so we can support them within our program’s scope.
Does your child have any diagnosed developmental delays or special needs?
*
Yes
No
If yes, please specify:
Strategies or activities that work well for your child
Section 6: Emergency Contact
Fulle Name
*
First Name
Middle Name
Last Name
Relationship to Child
*
Primary Phone
*
Alternate Phone
Section 7: Pick-Up Authorization
Authorized Person 1
*
Authorized Person 2
Authorized Person 3
Section 8: Additional Information
Is there anything else you’d like us to know about your child?
Section 9: Acknowledgment
Parent/Guardian Name
*
Date
*
-
Month
-
Day
Year
Date
Parent/Guardian Signature
*
Submt
Submt
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