Child Registration Form

Child Registration Form

Welcome to BrighCare !
Please complete this registration form to enroll your child(ren) in one of our licensed home daycares. The information you provide will help us ensure your child’s safety, well-being, and a smooth start in our program. All details are kept confidential and used only for daycare purposes.
Parent / Guardian Information
Full Name

First NameLast Name
Contact Number
Please enter a valid phone number.
Relationship to child
Phone number (primary)
Please enter a valid phone number.
Alternate phone
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child Information
Name

First NameLast Name
Gender

MaleFemale
Date of Birth

MonthDayYear
Hours of care from*

Hour Minutes

AM/PM Option
Hours of care To*

Hour Minutes

AM/PM Option
Allergies / Medical Conditions
Enrollment Details
Preferred Start Date

MonthDayYear
Date
Are you looking for a childcare that participates in the CWELCC (Canada-Wide Early Learning and Child Care) program?

YesNo
What is your approximate budget for your child’s care per week?

$200$300$400No maximum / Flexible
Should be Empty:

Parent / Guardian Information