REGISTRATION FORM
Instruction: This form to be filled up by the parents/guardian of the child upon enrollment to the
Child Development Center. This will be kept by the Child Development Teacher in the portfolio of the
child.
Name of Child: ______________________________________ Sex: M: _____ F: _____
Address: ___________________________________________ Birthday: _______________
Guardian: __________________________________________ Relationship: _________________
Registered: dd Yes No Age: ___________
Guardian Information: E-mail Address: ________________________
Mother:
Name: _____________________________________________ Occupation: ____________________
Address: ____________________________________________________________________________
Contact Number: Home: ____________________________ Work: __________________________
Father:
Name: _____________________________________________ Occupation: ____________________
Address: ____________________________________________________________________________
Contact Number: Home: ____________________________ Work: __________________________
IN CASE OF EMERGENCY, Please the following:
Name: _____________________________________________ Relationship: ____________________
Address: ____________________________________________________________________________
Contact Number: Home: ____________________________ Work: __________________________
Accomplished by: ___________________________________________ ___________________
Signature over printed name of parent/guardian Date
Reviewed by: ___________________________________________ ___________________
Signature over printed name of CDC Date