Completion of this agreement is required for enrollment. This form will enable us to better understand your child and meet his/her needs. Much of the information requested is necessary to comply with state child care licensing regulations.

Enrollment Information

If your child is participating in school age child care, please complete form titled, “School Age Child Care Supplemental Enrollment Form”

Child’s Information

Family Information

List family members & pets your child lives with – include first names, relation and ages of siblings

Child Emergency Contact and Release Information (do not include parents/guardians/sponsors)

Please notify the center if an Emergency Release Contact will pick up your child on a given day.
[For the safety of your child, we request that all authorized pick up persons with whom staff is not familiar provide a photo ID at the time of pick up.]