Parents Form

Name

Email Address

Phone

Has your child been in daycare before? Has your child been in daycare before?YesNo

If yes, how long?

Why was care terminated?

Can I contact the former day care provider, if you do not mind?

Is this your only child? If not how many siblings?

Is the child part of other groups like---sports/activity classes/play dates?

How long do you need child-care?

Does your child have any known health issues?

Does your child have any special needs (religious, food allergies, etc.)?

Are you (or a designated person) able to pick up the child in case of an incident or emergency?

Can you describe the personality of your child?