626 Child Care Registration FormThe Child Care Registration Form Template lets parents and guardians submit their kid’s information to you while they register for your child care center. Use this template to get photos, preferred start dates, and the times they need child care.Please enable JavaScript in your browser to complete this form.Preferred Child Care Center LocationBrushwoodPonte Pato BeachPortofino WestGrangerDeer LakePreferred Start DateDateTimeHours of Daycare RequiredMornings (Half Day)Afternoons (Half Day)Full DayDays RequiredMondayTuesdayWednesdayThursdayFridaySaturdaySundayParent Account DetailsParent/Guardian Name *FirstLastDoes/do the child(ren) live with you full time?YesNoPlease detail the living situation:Username *Email *Password *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Parent Photo * Click or drag a file to this area to upload. Emergency Contact Name *FirstLastEmergency Contact Phone *Student DetailsName *FirstLastDate of Birth *GenderFemaleMaleStudent's Doctor's Name *FirstLastStudent Health Insurance CompanyStudent's Doctor's Phone *Is anyone besides you allowed to pick up your child?NoYesPlease list who can pick up your child:Photos of those allowed to pick up your child: Click or drag a file to this area to upload. Please let us know about any behavioral concerns:Please let us know about any medical concerns:Please let us know about any allergies:Parent/Guardian Signature *Clear SignatureSubmit
