Dream Daycare Registration Form:
Father’s Name/Guardian Name
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Mother’s Name/Guardian Name
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Address:
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Postal Code:
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Home Phone:
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Work Phones:
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Cell Phones:
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Email:
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1st Child Name:
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First Name
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Last Name
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Birth date (dd/mm/yyyy)
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Is your child on any medication?
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Any Allergies?
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Toilet Trained
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2nd Child Name:
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First Name
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Last Name
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Birth date (dd/mm/yyyy)
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Is your child on any medication?
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Any Allergies?
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Toilet Trained
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Please indicate your child’s drop off and pick up time
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We (I) have received and have read the Policies and Procedures dated __________ and agree to abide by it.
Deposit: One weeks contracted fee will be paid at the time this contract is signed to serve as a deposit. This amount shall be applied to the last week of care provided.
Date Paid:________ Amount Paid:_______ Parent Initials:______
PARENT SIGNATURE: _______________________________________
PARENT SIGNATURE: _______________________________________
PROVIDER SIGNATURE: _____________________________________
DATE SIGNED: _______________
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