Childcare Registration Form Name Name First Name First Name Last Name Last Name Address: * City * State Zip Code Email Phone Child’s Name Child's Name First Name First Name Last Name Last Name Age of Child Date of Birth 1. Tell us a little about your child. What do you think is important for us to know? 2. Does your child have previous preschool or childcare experience? 3. What most interests your child? 4. How would you like to see your child grow in our program? 5. Does your child have any fears we should know about? 6. Infant/Toddler Parents – Can you tell us a little about your child’s feeding and napping schedule? 7. School Age Parents Only – We have three schedules – Before School, After School, Before and After School. Which are you interested in? 8. Please tell us what type of schedule you need (ie, full time, part time, specific days, etc) Captcha Submit If you are human, leave this field blank.
