CKITC Student Enrollment Form

CKITC Student Enrollment Form

Please fill out the child's and parent's information, select care days, and specify your preferences for start date and scheduling. Once this form is returned to me your $100 registration fee is due to lock in that spot.
Child 1 Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Allergies or Medical Conditions
Child 2 Information (if applicable)
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Allergies or Medical Conditions
Mother's Information
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer Name
Employer Phone Number
Father's Information
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer Name
Employer Phone Number
Doctor's Information
Doctor's Name
Doctor's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Room Preference
In the event the Emergency Room IS needed, do I call you first or 911?
Scheduling

Please fill out this form to the best of your knowledge as pricing will be based upon need. 3 days is considered full time. Any hours needed before 7am or after 7pm are priced as Extended Hours.
Expected Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Days of the Week Needed for Care
Drop Off Time

Hour Minutes

AM/PM Option
Pick Up Time

Hour Minutes

AM/PM Option
Saturday or Weekend Care Needed?
Do you understand that our cut off time is 10am and if you miss that time, you have to wait to drop off at 2pm?
You will be paying tuition for the week to come. Do you understand that payments are due on MONDAYS BEFORE you drop off, whether they will or wont be in attendance that day or that week?
Do you understand that this form serves as a legally binding contract between you and Capri's Kidds ITC and all policies and rules are expected to be followed without question and that failure to abide will result in termination?
Signature
Should be Empty:

CKITC Student Enrollment Form

Child 1 Information

Child 2 Information (if applicable)

Mother's Information

Father's Information

Doctor's Information

Scheduling