Second Term Childcare Program Registration Form

All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

يتم استلام جميع التسجيلات ومراجعتها على أساس من يأتي أولاً يخدم أولاً. عند ملء جميع المواقع المفتوحة، سيتم إضافة جميع الطلبات إلى قائمة الانتظار الخاصة بنا

Date

Hour MinutesAM/PM Option

Terms and Conditions

Which level are you wanting to register for?

CPR

Full Name

First NameMiddle NameLast Name

Gender

Birth Date

MonthDayYear

Home Phone

Format: 00000000.

Mobil

Villa

Road

City

Block

Full Name

First NameMiddle NameLast Name

CPR

Format: 000000000.

Mobil

Format: 00000000.

Work

Format: 00000000.

E-mail

example@example.com

Address - Same As Child

If your address is different than the childs please fill out the info below. Otherwise move onto the next section.

Parent/Guardian 1 Address

Villa

Road

City

Block

Full Name

First NameMiddle NameLast Name

CPR

Format: 000000000.

Mobil

Format: 00000000.

Work

Format: 00000000.

E-mail

example@example.com

Address - Same As Childs

If your address is different than the childs please fill out the info below. Otherwise move onto the next section.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Student CPR Upload

Student Birth certificate Upload

Father CPR Upload

Mother CPR Upload

Would your child like to be in a class with a friend?

If yes, name of friend(s)?

Is your child immunized?

Does your child have any allergies?

If yes please list, including any food or drug allergies.

Does your child have any medical conditions?

Does your child require any medication? If yes, please list these medications.

Do you authorize us to administer the medications listed above?

Please list the people authorized to pick up your child.

Does your child have any siblings?

If yes, what is their age(s)?

Comments

Full Name

First NameMiddle NameLast Name

Mobil # 1

Format: 00000000.

Mobil # 2

Format: 00000000.

Work

Format: 00000000.

Appointment

Amounts payable to Littlekindergarten BH34AUBB00006536060300 (Benefit Pay # 33802290)

Other

Total Amount

Benefit Pay Transaction massage Upload

Registration Form 2021

Little Captain Kindergarten Registration

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Infomation

Emergency Contact - Other than Parent/Guardian

Payment Infomation