2026–2027 Re-Enrollment Form

Parent/Guardian Information
Full Name

First NameLast Name
Relationship to Child
Phone Number

Area CodePhone Number
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Secondary Parent/Guardian Information
Full Name

First NameLast Name
Relationship to Child
Phone Number

Area CodePhone Number
Email Address
example@example.com
Child Information
Child's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

Other
Enrollment Information
Desired Start Date

MonthDayYear
Date
Program Selection

Weekly Days and Times of Care

Rows	Arrival Time	Departure Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Emergency Contacts
Emergency Contact Name

First NameLast Name
Relationship to Child
Phone Number

Area CodePhone Number
Additional Emergency Contact Name

First NameLast Name
Relationship to Child
Phone Number

Area CodePhone Number
Developmental Information
Please describe any developmental milestones, needs, or concerns.
Potty Training Information
Is your child potty trained?
If not fully potty trained, please provide details or instructions.
Medical/Allergy Information
Does your child have any allergies?
If yes, please list all allergies.
List any medical conditions or medications.
Tuition Agreement
Tuition is based on enrollment, not attendance. Tuition reserves the child’s space regardless of illness, vacation, holidays, weather closures, or absences.
Each family is contracted for up to 8 hours of care per day. Care beyond contracted hours may result in additional tuition charges.
The annual registration fee is non-refundable.
Late tuition payments may result in late fees and could affect continued enrollment.
Late pick-up policy: $1.00 per minute after the contracted pick-up time.
Attendance policy: at least two (2) hours’ notice is required before the child’s scheduled drop-off time for absences or schedule changes.
Permanent schedule changes must be requested in advance and are subject to availability.
Payment Method
Payment Due Date
Payment Amount
I have read, understand, and agree to the Tuition Agreement and all policies of The Creative Clubhouse LLC.
Electronic Signature
Signature Date

MonthDayYear
Date

Parent/Guardian Information

Secondary Parent/Guardian Information

Child Information

Enrollment Information

Emergency Contacts

Developmental Information

Potty Training Information

Medical/Allergy Information

Tuition Agreement

Office Use Only

Heading