Child Care Centre

Enrollment form

Child’s name: _________________________________________ DOB: _________________________

Address: _____________________________________________________ City: _________________

Landline #: _______________________________

Father’s name: _______________________________________ Mobile #: _______________________

Email: _______________________________________________

Mother’s name: ______________________________________ Mobile #: _______________________

Email: _______________________________________________

Guardian’s name: ______________________________________ Mobile #: ______________________

Email: _______________________________________________

Primary hours of daycare: From: ____________ To: ______________

Services: Playgroup After-school Adhoc care HW tutoring

Snacks offered: Snacks Milk

Has your child had any health problems or suffer from any allergies? Yes / No
If Yes, describe:

Parent’s signature