FULL-DAY APPLICATION FORM ONLY

GROUND UP DAYCARE

Please complete this application form to enroll your child in our kindergarten. Ensure all information is accurate and complete.
Child's Information

Please provide details about the child applying for enrollment.
Child's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2
CityRegionPostal / Zip Code
Gender
Class Options
Parent/Guardian 1 Information

Please provide details for the first parent or guardian.
Full Name (Parent/Guardian 1)

First NameLast Name
ID Number (Parent/Guardian 1)
Home Address (Parent/Guardian 1)

Street Address

Street Address Line 2
CityRegionPostal / Zip CodeCountry
Relationship to Child (Parent/Guardian 1)
Phone Number (Parent/Guardian 1)
Please enter a valid phone number.Format: (000) 000-0000.
Email Address (Parent/Guardian 1)
example@example.com
Workplace/School Name (Parent/Guardian 1)
Workplace/School Address (Parent/Guardian 1)

Street Address

Street Address Line 2
CityRegionPostal / Zip CodeCountry
Parent/Guardian 2 Information

Please provide details for the second parent or guardian.
Full Name (Parent/Guardian 2)

First NameLast Name
ID Number (Parent/Guardian 2)
Home Address (Parent/Guardian 2)

Street Address

Street Address Line 2
CityRegionPostal / Zip CodeCountry
Relationship to Child (Parent/Guardian 2)
Phone Number (Parent/Guardian 2)
Please enter a valid phone number.Format: (000) 000-0000.
Email Address (Parent/Guardian 2)
example@example.com
Workplace/School Name (Parent/Guardian 2)
Workplace/School Address (Parent/Guardian 2)

Street Address

Street Address Line 2
CityRegionPostal / Zip CodeCountry
Emergency Contact Information

Please provide an emergency contact other than the parents/guardians listed above.
Emergency Contact Name 1

First NameLast Name
ID Number (Emergency Contact)
Relationship to Child (Emergency Contact)
Phone Number (Emergency Contact)
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name 2

First NameLast Name
ID Number (Emergency Contact)
Relationship to Child (Emergency Contact)
Phone Number (Emergency Contact)
Please enter a valid phone number.Format: (000) 000-0000.
Are the emergency contacts also authorized to pick up the child without parent or guardian consent?
Doctor's Name
Doctor's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does the child have allergies?
Please describe how the child is like if they have allergies
Medications
Child's Dietary Restrictions

GROUND UP DAYCARE

Child's Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Emergency Contact Information