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Preschool Enrollment Form

The child enrollment form collects information about a child's parents/guardians, emergency contacts, schedule, and consent for pickup. It includes the child's name, date of birth, address, gender, ethnicity, SSN, and contact information for both parents. Parents provide their address, phone numbers, email, employer, and marital status. Emergency contacts and authorized pickup individuals are also listed along with their relationship and contact details. The child's planned schedule, including start/end times and days is outlined. Consent is provided by a parent's signature and date at the bottom.

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tracyladams
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127 views2 pages

Preschool Enrollment Form

The child enrollment form collects information about a child's parents/guardians, emergency contacts, schedule, and consent for pickup. It includes the child's name, date of birth, address, gender, ethnicity, SSN, and contact information for both parents. Parents provide their address, phone numbers, email, employer, and marital status. Emergency contacts and authorized pickup individuals are also listed along with their relationship and contact details. The child's planned schedule, including start/end times and days is outlined. Consent is provided by a parent's signature and date at the bottom.

Uploaded by

tracyladams
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

CHILD ENROLLMENT FORM

Date of Application: _______________ Date of Enrollment: ______________ Last Day of Enrollment:_________

Childs Name: __________________________________________


Childs SSN:

Childs Date of Birth: ____________________

Gender

Ethnicity:

Childs Address: ________________________________City: __________________________Zip Code:__________

Mothers Name: ____________________________________ Address:_____________________________________


City: _______________________Zip Code:_________ e-mail address:______________________________________
Home Telephone #: (_____)______________________________ Cell #: (_____)______________________
Mothers Employer: _____________________________________Work #: (____)__________________

Mothers Employer Address: _______________________ City: __________________________Zip Code:_________

Fathers Name: ________________________________ Address: _______________________________

City: ________________________Zip Code:_________ e-mail address: ___________________________________


Home Telephone #: (_____)__________________________

Cell #: (____)_______________________

Fathers Employer: _______________________________________ Work #: (____)___________________


Fathers Employer Address: _______________________ City: __________________________Zip Code:_________

Parents Marital Status:

Married

Separated

Divorced

Child lives with:


If Parents are divorced, who has legal custody:
May the non-custodial parent pick up the child:

Is the child currently in childcare:


Sitter

Daycare

Family Member

Other

Single

Widowed

We are open Monday-Friday from 7:30am-5:30pm and offer two options for care:
Full-time (all day)

or

After school (from 3pm-5pm)

Weekly Care Schedule: (please indicate the childs hours in care for each day)
Monday:

_________________(am / pm) to _________________(am / pm)

Tuesday:

_________________(am / pm) to _________________(am / pm)

Wednesday:

_________________(am / pm) to _________________(am / pm)

Thursday:

_________________(am / pm) to _________________(am / pm)

Friday:

_________________(am / pm) to _________________(am / pm)

If registering for after school care, will your child be attending full time during the summer:

Yes

No

Persons to Call in an Emergency or Release Child to (if parent(s) cannot be reached)


Name: _______________________________________ Address: ______________________________________
Phone #: (____)________________ Phone #: (____)________________ Relationship: _________________

Name: _______________________________________ Address: ______________________________________


Phone #: (____)________________ Phone #: (____)________________ Relationship: _________________

Name: _______________________________________ Address: ______________________________________


Phone #: (____)________________ Phone #: (____)________________ Relationship: _________________

Additional persons child may be released to:


Name: _____________________________

Address: ______________________________________________

Phone #: (____)________________ Phone #: (____)________________ Relationship: _________________

Name: _____________________________

Address: ______________________________________________

Phone #: (____)________________ Phone #: (____)________________ Relationship: _________________

Name: _____________________________

Address: ______________________________________________

Phone #: (____)________________ Phone #: (____)________________ Relationship: _________________

Signature of Parent or Guardian _________________________________________ Date: _____________________

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