Printable Daycare Form PDF Details

Filling out a daycare registration form is a crucial step in securing a spot for your child in a nurturing and educational environment like Westbrook Christian School, located on Westminster Drive in Rainbow City, AL. These forms, intricate and detailed, require parents to provide comprehensive information covering a wide array of topics - from basic child and parent details, siblings, and living arrangements to medical information including allergies, medical history, and emergency contacts. Additionally, it touches on social information that paints a picture of the child's personality, habits, and routines. Religious affiliations and preferences are also inquired about, reflecting the institution's holistic approach to child care and upbringing. Furthermore, a significant component of the form is the daycare contract, clearly outlining the operational days, fee structure, and policies on late pickups, essentially setting the expectations and responsibilities of both the daycare providers and the parents. This detailed document ensures that both parties are well informed and agree upon the care level and operational logistics, aiming for a smooth and beneficial relationship for the child's growth and development.

QuestionAnswer
Form NamePrintable Daycare Form
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namesmedical form for children in daycare, drop in forms for daycare, daycare contracts and forms, daycare forms

Form Preview Example

WESTBROOK CHRISTIAN SCHOOL

100 Westminster Drive

Rainbow City, AL 35906

(256)442-7457

www.westbrookchristian.org

DAYCARE REGISTRATION FORM

(3K & 4K)

============================================================================================

CHILD’S NAME:________________________________________________________________

PARENT(S):___________________________________________________________________

NAME CHILD GOES BY:______________________________ MALE FEMALE

(Circle one)

CHILD’S HOME ADDRESS:_______________________________________________________

Street Address/P.O. Box/Apartment Number

_______________________________________________________

City/State/Zip Code

TELEPHONE: (_____)________________________ SOCIAL SECURITY #:_______________

AGE OF CHILD:__________________________ BIRTHDAY: _________________________

MOTHER’S NAME:______________________________________________________________

HOME ADDRESS:______________________________________________________________

Street Address/P.O.Box/Apartment Number

______________________________________________________________

City/State/Zip Code

MOTHER’S OCCUPATION:______________________________________________________

TELEPHONE NUMBERS: Home: (_____)______________________________________

Work: (_____)______________Ext._________ Cell: (_____)__________________________

FATHER’S NAME:______________________________________________________________

HOME ADDRESS:______________________________________________________________

Street Address/P.O. Box/Apartment Number

______________________________________________________________

City/State/Zip Code

FATHER’S OCCUPATION:______________________________________________________

TELEPHONE NUMBERS: Home: (_____)______________________________________

Work: (_____)______________Ext._________ Cell: (_____)__________________________

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Page 1 of 7

FAMILY

Give names and ages of your child’s siblings:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

PARENTS’ MARITAL STATUS:

Married

Separated

Divorced

Widowed

 

 

 

(Circle one)

 

If parents are separated, who has custody of the child? ________________________________

A copy of the most recently issued Court Order providing custody status must be on file with the school.

List persons approved to call for child (Child will not be released to others without specific permission from parents.):________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

MEDICAL

NAME OF CHILD’S PHYSICIAN:___________________________________________________

PHYSICIAN’S TELEPHONE NUMBER: (_____)_______________________________________

Persons to be called in case of emergency if parents are unavailable:

NAME:_______________________________________________________________________

RELATIONSHIP:________________________ TELEPHONE: (_____)__________________

NAME:_______________________________________________________________________

RELATIONSHIP:________________________ TELEPHONE: (_____)__________________

Should my child, _____________________________________, become ill or suffer an accident

of any nature while in the care of Westbrook Christian School Daycare, Rainbow City, Alabama, the Preschool Director shall undertake to contact me immediately. In the event she is unable to reach me immediately, she will attempt to reach one of the above listed persons. Should this be impossible, the Director shall be authorized to secure and consent to such medical attention, treatment, and services for my child if given by me in person. I agree to assume the responsibility for payment of all medical costs incurred and not covered by the insurance.

Date:____________________ Parent(s) Signature:___________________________________

____________________________________

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Page 2 of 7

Check any of the following your child has had:

_____Whooping Cough

_____Chicken Pox

_____Appendicitis

_____Measles

_____Diphtheria

_____Head injury

_____German Measles

_____Prolonged high fever

_____Asthma

_____Mumps

_____Tonsillitis

_____Acute ear infections

_____Hay Fever

_____Convulsions

_____Rheumatic Fever

_____Other____________________________________________________________________

What allergies does your child have? _______________________________________________

List other medical information that you feel might help us:________________________________

_____________________________________________________________________________

SOCIAL INFORMATION

Is this your child’s first separation from home? _______________________________________

Has your child had any kind of group experience? Describe:_____________________________

_____________________________________________________________________________

Does your child make new friends easily? ___________________________________________

Is your child toilet trained? ________________________________________________________

What special words does your child use to tell you he/she needs to urinate or have a bowel movement? __________________________________________________________________

What time does your child get up in the morning? ____________________________________

What time does your child go to bed at night? ________________________________________

Is your child accustomed to taking an afternoon nap? _______ For how long? ______________

Does your child have any special nap or bedtime routine? ______________________________

_____________________________________________________________________________

What time does your child usually have: Breakfast________ Lunch_________ Dinner________

Is your child accustomed to having between meal time snacks? __________________________

Does your child need any help feeding himself/herself? ________________________________

What fears does he/she have (such as animals, storms, etc.)?____________________________

_____________________________________________________________________________

How do you handle these fears? __________________________________________________

Other comments and special instructions: ___________________________________________

_____________________________________________________________________________

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RELIGIOUS AFFILIATION

What church do you attend?_______________________________________________________

Do you attend: Regularly_______ Occasionally_______ Seldom_______

Is your child enrolled in Sunday School? ____________________________________________

If not a church member, give a church preference: ____________________________________

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Westbrook Christian School

Daycare Contract

Please complete the following:

Child’s name: ______________________________________________

Days my child is enrolled in preschool:

Mon. Tues. Wed. Thurs. Fri.

Days daycare is needed:

Mon. Tues. Wed. Thurs. Fri.

Charges for daycare are as follows: $12.00 (includes lunch) 12:00-5:30

Late charge of $5.00 per every 2 minutes for pickup after 5:30 p.m.

I agree to pay Westbrook Christian School daycare with post-dated checks for the days I have enrolled my child in daycare. Daycare charges will apply even in the event that my child is unable to attend.

Parent’s signature: ____________________________________________

Date: _______________________________________________________

WESTBROOK CHRISTIAN SCHOOL

Child’s Medical Report – Daycare

CHILD’S NAME:__________________________________ DATE OF BIRTH:_______________

PARENT OR GUARDIAN’S NAME:_________________________________________________

HOME ADDRESS:______________________________________________________________

Street Address/P.O.Box/Apartment Number

______________________________________________________________

City/State/Zip Code

HOME TELEPHONE: (_____)_____________________________________________________

Attach Certificate of Immunizations (blue slip) for children age 4 years and older. If blue slip is not available or if child is 3 years of age and under, complete the section below.

IMMUNIZATIONS

 

 

Type of Immunizations

 

Number Given as of Date of

 

 

this Examination

DTP or DT

 

____________

Polio

 

____________

Red Measles

 

____________

Rubella (German Measles)

 

____________

Mumps (Optional)

 

____________

Immunizations are up to date for age of child

Yes_______

No_______

Laboratory and other testings (if indicated):

Yes_______

No_______

History of Allergies:_____________________________________________________________

_____________________________________________________________________________

=========================================================================

I examined this child on this date _________________. I find him/her to be in good physical condition, free of contagious

and infectious diseases, and capable of participating in daycare activities, except as noted below.

DATE:________________ PHYSICIAN’S SIGNATURE:________________________________

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Page 6 of 7

STATE OF ALABAMA

AFFIDAVIT FOR PARENT/GUARDIAN

COUNTY OF ETOWAH

Before me, a Notary Public in and for said State and County, appeared

________________________________________________________________

and is known to me, after being duly sworn or affirmed, says as follows:

The affiant is the parent or legal guardian of the minor child/children

_____________________________________: that affiant has been notified by

Sandra Handley, a representative of Westbrook Christian School, that said church or school has filed notice and is exempt under law from regulation by The Department of Human Resources.

____________________________________ parent/legal guardian sworn,

or affirmed to and subscribed before me this _______ day of _______________,

20_______.

________________________________

NOTARY PUBLIC

My Commission Expires:____________

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Westbrook Christian School

After-school Care Contract

5K – 6th

After-school care for 5K – 6th grade is set up on a contract system. Due to limited space, availability will be based on a first-come, first-serve basis. Therefore, the sooner we receive your completed contract—the better chance you will have of obtaining a place for your child(ren).

Please complete and return the following:

Child’s Name: ____________________________________________________

If enrolling more than one child, you may use one contract for all of your children as long as they are enrolled for the same time periods. If not, please complete a separate contract for each child.

Circle the days your child will need after-school care:

Monday

Tuesday

Wednesday

Thursday

Friday

Circle the hours your child will need after-school care:

A

2:30 p.m. – 3:30 p.m.

B

2:30 p.m. – 4:30 p.m.

C

2:30 p.m. – 5:30 p.m.

Cost is $3.00 per hour. After choosing the contract plan, bookkeeping will provide you with a list of cost per month based on the school calendar.

You are choosing between three contracts, which are set up to allow for pick-up any time during the time frame set by the selected contract. Your cost is based on the particular contract you select. If you are late picking up your child(ren) more than once, you will automatically be switched to the next contract.

Adjustments to your payments will be made at that time. There is a late fee of

$5.00 for every 2 minutes past 5:30 p.m.

I agree to pay Westbrook Christian School with post-dated checks (dated August, 2010 – May, 2011) for the hours I have enrolled my child(ren) in after-school care. These charges will apply even in the event my child is unable to attend.

Parent’s signature: __________________________________ Date: ________

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daycare lady forms spaces to complete

In the CityStateZip Code, MOTHERS OCCUPATION, TELEPHONE NUMBERS, Home, Work Ext Cell, FATHERS NAME, HOME ADDRESS, Street AddressPO BoxApartment, CityStateZip Code, FATHERS OCCUPATION, TELEPHONE NUMBERS, Home, and Work Ext Cell area, jot down your information.

daycare lady forms CityStateZip Code, MOTHERS OCCUPATION, TELEPHONE NUMBERS, Home, Work Ext Cell, FATHERS NAME, HOME ADDRESS, Street AddressPO BoxApartment, CityStateZip Code, FATHERS OCCUPATION, TELEPHONE NUMBERS, Home, and Work Ext Cell blanks to insert

Within the field referring to Give names and ages of your childs, PARENTS MARITAL STATUS, Married Separated Divorced Widowed, Circle one, If parents are separated who has, A copy of the most recently issued, List persons approved to call for, permission from parents, and MEDICAL, you need to note down some expected details.

Completing daycare lady forms stage 3

In the section NAME OF CHILDS PHYSICIAN, PHYSICIANS TELEPHONE NUMBER, Persons to be called in case of, NAME, RELATIONSHIP TELEPHONE, NAME, RELATIONSHIP TELEPHONE, Should my child become ill or, and Date Parents Signature, list the rights and responsibilities of the sides.

Finishing daycare lady forms step 4

End by looking at the following areas and filling them out accordingly: Check any of the following your, Whooping Cough Measles German, Chicken Pox Diphtheria Prolonged, Appendicitis Head injury Asthma, What allergies does your child, List other medical information, SOCIAL INFORMATION, Is this your childs first, Has your child had any kind of, Does your child make new friends, Is your child toilet trained, What special words does your child, and movement.

stage 5 to entering details in daycare lady forms

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