Sample Daycare Registration Form printable pdf download

SHAWKWUNLEE DAYCARE

Registration Form

Date: _________________________

Child’s Name: _________________________

Is your child a CAFN Citizen? (Y/N)

Date of Birth: __________________________

Sex: ____________

Address: ______________________________

Phone: _____________________________

Type of care needed:

Full-time (Mon-Fri) Hours: __________ to __________

Other: _________________________________________

Parent/Guardian: ___________________________ Relationship to child: _______________

Home Address: ________________________________________________________________

Occupation: __________________________________________________________________

Workplace/School: _____________________________________________________________

Phone numbers: Home ________________

Work/school: _______________________

Cell __________________

Parent/Guardian: ___________________________ Relationship to child: ______________

Home Address: _______________________________________________________________

Occupation: __________________________________________________________________

Workplace/School: ____________________________________________________________

Phone numbers: Home ________________

Work/school: _______________________

Cell ________________

Brothers, sisters or others living in the child’s home:

Name: _________________________ Age: _______ Relationship: _____________________

Pets: ________________________________________________________________________

ALTERNATE CONTACTS

The following persons are authorized to pick up my child in the case of an emergency:

Please provide at least 2 alternate contacts

Name: ______________________________________ Relationship: ____________________

Address: ____________________________________________________________________

Phone number(s): _____________________________________________________________

Name: ______________________________________________________________________

Address: _____________________________________________________________________

Phone number(s): ______________________________________________________________

Name: _______________________________________________________________________

Address: ______________________________________________________________________

Phone number(s): ___________________________________________________________

Shawkwunlee Daycare Registration Form

Sample Daycare Registration Form