Wee Care Child Care Enrollment Application

Wee Care Child Care Enrollment Application
Section 01: General Information
Location you're interested in:
Start Date

MonthDayYear
Date
Child's Date of Birth

MonthDayYear
Date
Name of Child
Name of Parent or Guardian #1
Name of Parent or Guardian #2
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Emergency Phone
Please enter a valid phone number.
Your Email*
example@example.com
Type of Family:

2-Parent1-ParentGuardian
Section 02: Parent(s) or Guardian(s) Information
Father's Name
Father's Date of Birth

MonthDayYear
Date
Father's Occupation
Father's Place of Employment
Father's Address
Father's Phone Number
Mother's Name
Mother's Date of Birth

MonthDayYear
Date
Mother's Occupation
Mother's Place of Employment
Mother's Address
Mother's Phone Number
Legal Guardian's Name
Guardian's Date of Birth

MonthDayYear
Date
Guardian's Occupation
Guardian's Place of Employment
Guardian's Address
Guardian's Phone Number
Section 03: Please list the names of those living with your child
Number of Brothers
Number of Sisters
First and Last Name
Relationship
Age
First and Last Name
Relationship
Age
First and Last Name
Relationship
Age
First and Last Name
Relationship
Age
First and Last Name
Relationship
Age
Section 04: Pick-up Policy
The safety of your children is our most important responsibility. We must have a list of anyone that may be picking up your child(ren). If there are any changes to this list, you must inform the staff when you are dropping off your child(ren) for the day. If there is a permanent change to the listed individuals, you must complete a new "Pick-up Policy" form. A child will not be permitted to leave with anyone other than those listed on this Enrollment Application unless we have your signature on a written authorization. Please inform the people that you have listed on this Enrollment Application that the staff will be asking for proper identification before allowing any child to leave the center. A completed Enrollment Application must be on file for each child that you have enrolled in the center.
Name of Child
First/Last Name
Relationship
First/Last Name
Relationship
First/Last Name
Relationship
First/Last Name
Relationship
First/Last Name
Relationship
First/Last Name
Relationship
First/Last Name
Relationship
Should be Empty:

Wee Care Child Care Enrollment Application

Section 01: General Information