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.Format: (000) 000-0000.
Relationship to child
Phone number (primary)
Please enter a valid phone number.Format: (000) 000-0000.
Alternate phone
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Child Information
Name

First NameLast Name
Gender
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
Requested Area
Requested area
Our providers are highly qualified or hold an ECE diploma. They charge starting at $40 per day. What is your approximate budget for your child’s care per week?

Other
Should be Empty:

Parent / Guardian Information