Registration Form "Little Me with Daycare LLC"

Little Me with Daycare LLC

Registration Form
Before filling out this registration form, please make sure you have received a quote and agreed on the price. Thank you!
Parent/Provider Contract
1 Child Name *

First NameLast Name
Upload Child’s Photo*
Date of Birth*

MonthDayYear
Date
Allergies / Medical / Mental conditions *
Start Date

MonthDayYear
Date

Daycare Schedule*

I allow my child to be photographed and pictures to be used by Little Me Daycare for Daycare purposes.

YesNoOther

ICCP Info

(If you qualify for ICCP please sign, if not Skip this Step.)
Parents/guardians signing this contract is responsible for the payment of childcare charges for their child regardless if they are ICCP or not. If for any reason ICCP does not cover the month, the parent signing this contract is responsible for full month payment. Registration fee is non refundable. Tuition is non refundable.

If the schedule for childcare shall change a new contract must be filled out and signed. Provider has the right to update and change policies and tuition as needed with advance notice to the parents. Parents must give 30 day written notice if they are terminating their contract. Failure to do so will result in the charge of full month of tuition.
Signature

Clear

PARENT INFORMATION
Mother's First and Last name
Mother's phone number
Please enter a valid phone number.
Mother's address
Mother's email
example@example.com
Mother's work address and phone number
Father's First and Last name
Father's phone number
Please enter a valid phone number.
Father's address
Father's email
example@example.com
Father's work address and phone number
Please list below anyone who is not allowed to pick up a child. In the event that you wish to list the other parent, PLEASE make sure that I have legal documents to prevent them from doing so, otherwise I can not stop them from taking his/her child from daycare.
EMERGENCY CONTACTS/PICK UP LIST:

Please list below the persons authorized to pick up your child in the event of an emergency or when you cannot get here on time:
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
How did you hear about us
WE APPRECIATE YOUR BUSINESS.

THANK YOU FOR CHOOSING

LITTLE ME WITH DAYCARE AS YOUR CHILDCARE.
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Little Me with Daycare LLC