Printable Daycare Form PDF Details

Printable daycare forms can be extremely helpful in providing a smooth and stress-free experience when arranging for child care. This type of form is typically provided by the daycare center, and it outlines all of the necessary information pertaining to your child's stay. By having a copy of this form ahead of time, you can ensure that all of your questions are answered and that you have everything you need to drop your child off confidently. Printable daycare forms usually include the following information: emergency contact information, policies and procedures, health history, medication authorization (if applicable), dietary restrictions (if applicable), and anything else specific to your child's care.

Here, you'll find a number of information about printable daycare form PDF. This figure can provide information regarding the form's length, finalization time, and the areas you may be expected to fill.

Form NamePrintable Daycare Form
Form Length8 pages
Fillable fields132
Avg. time to fill out28 min 24 sec
Other namesdaycare contracts and forms, daycare lady forms, daycare blank forms, childcare forms

Form Preview Example


100 Westminster Drive

Rainbow City, AL 35906



(3K & 4K)


CHILD’S NAME:________________________________________________________________


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


Give names and ages of your child’s siblings:












(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.):________________________________________________________




NAME OF CHILD’S PHYSICIAN:___________________________________________________

PHYSICIAN’S TELEPHONE NUMBER: (_____)_______________________________________

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


RELATIONSHIP:________________________ TELEPHONE: (_____)__________________


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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Check any of the following your child has had:

_____Whooping Cough

_____Chicken Pox




_____Head injury

_____German Measles

_____Prolonged high fever




_____Acute ear infections

_____Hay Fever


_____Rheumatic Fever


What allergies does your child have? _______________________________________________

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



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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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: _______________________________________________________


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.




Type of Immunizations


Number Given as of Date of



this Examination







Red Measles



Rubella (German Measles)



Mumps (Optional)



Immunizations are up to date for age of child



Laboratory and other testings (if indicated):



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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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 _______________,




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:






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


2:30 p.m. – 3:30 p.m.


2:30 p.m. – 4:30 p.m.


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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