Enrollment Agreement Bup - 1 World Learning Center

Enrollment Agreement

12901 NW 27th Avenue*786-416-9940

Early Childhood Education Center

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
Child’s first name*
Child’s middle name*
Child’s last name
Child’s nickname
Age
Sex
Child’s primary language
Parent/guardian/sponsor primary language
Address
Child’s home address City State ZIP Code
Does your child attend school?*
- Yes
- no
School name
Grade
School phone
School address
Drop off time

: HH

MM

AM/PM
Pick-up time

: HH

MM

AM/PM
Family Information

List family members & pets your child lives with – include first names, relation and ages of siblings
Parent/guardian/sponsor*
Relationship to child*
Home phone
Cell phone
Home address if different from above
Home address if different from above City State Zip
Home email
Work email
Work phone
Employer address
Street Address Address Line 2 City State Zip
Work hours
Other parent/guardian/sponsor*
Relationship to child*
Home phone
Cell phone
Home address if different from above
Home address if different from above City State Zip
Home email
Work email
Work phone
Employer address
Street Address Address Line 2 City State Zip
Work hours
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.]
Person #1*
Relationship to child*
Home phone
Cell phone
Home address
Home address if different from above City State Zip
Home email
Work email
Work phone
Employer address
Street Address Address Line 2 City State Zip
Work hours
Person #2*
Relationship to child*
Home phone
Cell phone
Home address
Home address if different from above City State Zip
Home email
Work email
Work phone
Employer address
Street Address Address Line 2 City State Zip
Work hours
CAPTCHA

Enrollment Agreement

12901 NW 27th Avenue*786-416-9940

Early Childhood Education Center

Enrollment Information

Child’s Information

Family Information

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