Printable Daycare Form – Fill Out and Use This PDF

Daycare Registration Form (3K & 4K) at a glance

What it is: Daycare Registration Form (3K & 4K) of Westbrook Christian School, 100 Westminster Drive Rainbow City, AL 35906, (256) 442-7457.

Who signs: Write the Parent's signature and the Date.

A filled-in Daycare Registration Form (3K & 4K) example: a parent fills in the child and both parents

How to fill out Daycare Registration Form (3K & 4K), box by box

Child, mother and father: names, home addresses, occupations, telephones, Social Security # and birthday

Daycare Registration Form (3K & 4K), Westbrook Christian School, 100 Westminster Drive Rainbow City, AL 35906, (256) 442-7457. Write the CHILD'S NAME, the PARENT(S), the NAME CHILD GOES BY and the CHILD'S HOME ADDRESS (Street Address/P.O. Box/Apartment Number, then City/State/Zip Code), and circle MALE or FEMALE (Circle one). Write the TELEPHONE, the SOCIAL SECURITY #, the AGE OF CHILD and the BIRTHDAY. Write the MOTHER'S NAME and the HOME ADDRESS (Street Address/P.O.Box/Apartment Number, then City/State/Zip Code), the MOTHER'S OCCUPATION and the TELEPHONE NUMBERS: Home, Work (with Ext.) and Cell. Write the FATHER'S NAME and the HOME ADDRESS (Street Address/P.O. Box/Apartment Number, then City/State/Zip Code), the FATHER'S OCCUPATION and the TELEPHONE NUMBERS: Home, Work (with Ext.) and Cell.

More rules for Daycare Registration Form (3K & 4K)

Give names and ages of your child's siblings, and circle PARENTS' MARITAL STATUS: Married, Separated, Divorced or Widowed (Circle one). If parents are separated, write 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.). Write the MEDICAL NAME OF CHILD'S PHYSICIAN and the PHYSICIAN'S TELEPHONE NUMBER. Under Persons to be called in case of emergency if parents are unavailable, write the NAME, RELATIONSHIP and TELEPHONE of each person. Should my child, write the child's name, 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.

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 or Other. Write What allergies does your child have? and List other medical information.

Under SOCIAL INFORMATION, write: 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?

Write: 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?

Write what fears he/she has (such as animals, storms, etc.), how you handle these fears and any other comments and special instructions.

Under RELIGIOUS AFFILIATION, write What church do you attend? Do you attend: Regularly, Occasionally or Seldom. Is your child enrolled in Sunday School? If not a church member, give a church preference.

Please complete the following: Child's name, Days my child is enrolled in preschool (Mon., Tues., Wed., Thurs., Fri.) and Days daycare is needed (Mon., Tues., Wed., Thurs., Fri.).

Daycare charges will apply even in the event that my child is unable to attend.

Write the CHILD'S NAME, DATE OF BIRTH, PARENT OR GUARDIAN'S NAME, HOME ADDRESS and 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 IMMUNIZATIONS.

Under IMMUNIZATIONS, write the Number Given as of Date of this Examination for DTP or DT, Polio, Red Measles, Rubella (German Measles) and Mumps (Optional), mark Yes or No for Immunizations are up to date for age of child and for Laboratory and other testings (if indicated), and write the History of Allergies. Then the PHYSICIAN writes the date: I examined this child on this date. Then the PHYSICIAN writes: 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. Last, the PHYSICIAN writes the DATE and the PHYSICIAN'S SIGNATURE.

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.

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.

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.

Write the Parent's signature and the Date.

Common questions about Daycare Registration Form (3K & 4K)

Sources

[1] Daycare Registration Form (3K & 4K), Westbrook Christian School (the Official source link on this page).