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SUNSHINE PLAYSCHOOL DAYCARE CENTER
Additional Child Enrollment Application
Child's Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Sex
Mother's Name
Mother's Address
Mother's Phone #
Format: (000) 000-0000.
Mother's Employer
Employer Address
Employer Phone #
Format: (000) 000-0000.
Father's Name
Father's Address
Father's Phone #
Format: (000) 000-0000.
Father's Employer
Employer Address
Employer Phone #
Format: (000) 000-0000.
Do parents live together? Yes / No
Yes
No
If No, may non-custodial parent pick up? Yes/No
Yes
No
Primary Parent Email Address
example@example.com
Known Allergies
Does the child take any medication?
Any known learning or medical disabilities?
Child's Doctor
Doctor Phone #
Format: (000) 000-0000.
Center uses Dr. Chaplin (770) 460-2131 or Southern Regional Hospital (770) 991-8000.
Meal Preferences:
Meat
Vegetarian
No Milk
No Milk Products
Any preference other than Meat must have a doctor's note.
Emergency Contacts
Contact 1 Name
Phone #
Format: (000) 000-0000.
Complete Address
Authorized Pick Up? Yes / No
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Contact 2 Name
Phone #
Format: (000) 000-0000.
Complete Address
Authorized Pick Up? Yes / No
Contact 3 Name
Phone #
Format: (000) 000-0000.
Complete Address
Authorized Pick Up? Yes / No
I HAVE READ AND ACCEPT ALL CONDITIONS IN THE TUITION AGREEMENT PROVIDED IN MY FIRST CHILD'S APPLICATION PACKET.
Printed Name
Signature
Date
-
Month
-
Day
Year
Date
Save
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