Daycare Drop Off Request
IN ORDER TO BE ABLE TO DROP OFF YOUR KID(S) YOU MUST HAVE COMPLETED AN ENROLLMENT PACKET. If you have not completed a packet, please contact Kim Brown at kbrown@lifepoint.org. This form MUST be filled out AT LEAST 2 business days prior to your need to use the Lifepoint Staff Daycare.
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
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Area Code
Phone Number
Date of drop off
*
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Month
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Day
Year
Date Picker Icon
Are there any other dates you would like to schedule a drop off? If so please specify those dates here.
What time will you be dropping off your kid(s)
*
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Hour
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10
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40
50
Minutes
AM
PM
AM/PM Option
What time will you pick up your kid (s)
*
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:
Hour
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10
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30
40
50
Minutes
AM
PM
AM/PM Option
How many children are you dropping off?
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Name of Child #1
*
First Name
Last Name
Name of Child #2
First Name
Last Name
Name of Child #3
First Name
Last Name
Comments:
Submit
Should be Empty: