NEW CHILD REGISTRATION

NEW CHILD REGISTRATION

Please complete as much information as possible in the form below. If NOT APPLICABLE, please put N/A.
- Child's Full Name:
- Child's Age
- Birth Date
  
  MonthDayYear
- Gender:
- Any Allergies/Health concerns:
- Any Known Learning Difficulties:
- Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Home Phone Number:
- Desired Start Date
  
  YearMonthDay
  Date
- Are you looking for Full-Time or Part-Time?
- If Part-Time, on which days will you need Daycare?
- How many other Child Care Centers/Day Cares have you interviewed?
- How long are you seeking Child Care for?
- What are your current Child Care arrangements?
- Can someone pick up the child from the daycare if he/she is sick?
- Why are you leaving your current Child Care provider, if any?
- What is your biggest concern with Child Care outside your home?
- Is there any reason, activities for your child will be restricted?
- Is there anything else you would like to discuss at the interview?
- How did you hear about us?
- Which days are you available for a visit?
- How much per hour are you expecting to pay for your child's care?
- THE NEXT SET OF QUESTIONS IS FOR THE CHILD'S FATHER OR GUARDIAN 1
  
  If not applicable, please put N/A
- Please enter the Father/First Guardian's Full Name
  
  First NameLast Name
- Home Phone Number
  
  Area CodePhone Number
- Mobile Number
  
  Area CodePhone Number
- Email Address:
- Address (if different from Child)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Occupation
- Company Father/First Guardian works for:
- Work Phone Number
  
  Area CodePhone Number
- THE NEXT SET OF QUESTIONS IS FOR THE CHILD'S MOTHER OR GUARDIAN 2
  
  If not applicable, please put N/A
- Please enter the Mother/Second Guardian's Full Name:
- Home Phone Number
  
  Area CodePhone Number
- Mobile Phone Number
  
  Area CodePhone Number
- Email
  example@example.com
- Address (if different from Child)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Occupation
- Work Phone Number
  
  Area CodePhone Number
- Company Mother/Second Guardian works for:
- Any Additional Comments/Concerns
- Should be Empty:

NEW CHILD REGISTRATION

THE NEXT SET OF QUESTIONS IS FOR THE CHILD'S FATHER OR GUARDIAN 1

THE NEXT SET OF QUESTIONS IS FOR THE CHILD'S MOTHER OR GUARDIAN 2