Registration Form

Registration Form

Please fill out the information below to register your child. Up to three children may be registered using this form. Registration is not complete until this form has been submitted along with the $100 non-refundable registration fee (per family).
Parent/Caregiver Information

Please enter the information for the primary adult contact.
Full Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Relationship to Child*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?*
Please Specify
- Full Name
  
  First NameLast Name
- Phone Number
  Format: (000) 000-0000.
- E-mail
  example@example.com
- Relationship to Child
- Address (leave blank if same as above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Child's Information
  
  Children must be at least 3 years old (and potty trained) by September 1. You may register up to three children per form.
- Full Name*
  
  First NameLast Name
- Preferred Name*
- Date of Birth*
  
  MonthDayYear
  Date
- FemaleMaleOther/Prefer not to say
- MondayTuesdayWednesdayThursdayFriday
- Full Name
  
  First NameLast Name
- Preferred Name
- Date of Birth
  
  MonthDayYear
  Date
- FemaleMaleOther/Prefer not to say
- MondayTuesdayWednesdayThursdayFriday
- Full Name
  
  First NameLast Name
- Preferred Name
- Date of Birth
  
  MonthDayYear
  Date
- FemaleMaleOther/Prefer not to say
- MondayTuesdayWednesdayThursdayFriday
- Thank you for your interest in Kid's Day Out at Dayspring. After submitting this form, you will receive an email from the KDO team to schedule a tour of the facility. We look forward to meeting you!
  
  Note: Please allow up to 48 hours to receive the follow-up email. Thanks!
Should be Empty:

Registration Form

Parent/Caregiver Information

Child's Information

Thank you for your interest in Kid's Day Out at Dayspring. After submitting this form, you will receive an email from the KDO team to schedule a tour of the facility. We look forward to meeting you!