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DIRECTOR S USE ONLY CHILD S ENROLLMENT RECORD Date enrolled Child s full legal name First Middle Sex Child s preferred name/nickname Address Primary hours child will be in the children s center Days of week child will be in the children s center Who has legal custody Last Birth Date Street Address number apartment street Relationship City State Home Phone Parent s Name Zip Code Cell Phone Place of Employment Address of Employer Telephone The child will be released only to the person s authorized or in the manner authorized in writing by the custodial parent s or legal guardian s. The following person must be someone other than the custodial parent s or legal guardian s and is authorized to remove the child from the facility in case of illness accident or emergency if for some reason the custodial parent s or legal guardian s cannot be reached Name CONTINUED ON PG 2 Child s Physician/Health Resource Telephone Number Hospital Preference Name of Dentist MISCELLANEOUS INFORMATION List all ....

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How to fill out the Child Enrollment Record Form online

Completing the Child Enrollment Record Form online is an important step in ensuring that your child is safely enrolled in the children’s center. This guide will help you navigate the form with ease and confidence, providing you with essential instructions for every section.

Follow the steps to successfully complete the enrollment form.

  1. Click the ‘Get Form’ button to access the enrollment form and open it in your preferred editor.
  2. Begin filling out the child’s full legal name, including first, middle, and last names, in the respective fields provided.
  3. Indicate the child's sex by selecting the appropriate option.
  4. Input the child's preferred name or nickname if different from their legal name.
  5. Provide the child's address, including street address, city, state, and zip code.
  6. Specify the primary hours during which the child will be at the children’s center, along with the days of the week they will attend.
  7. Identify who has legal custody of the child and include their address and relationship to the child.
  8. Enter the parent's or guardian's details, including name, home phone, cell phone, address (with street, city, state, and zip code), and place of employment.
  9. List authorized persons other than the custodial parent(s) or legal guardian(s) who may pick up the child in case of emergencies. Ensure to provide their contact information.
  10. Fill out the child's physician or health resource details, including their telephone number and address.
  11. Indicate the preferred hospital and the name and address of the child's dentist.
  12. Complete the miscellaneous information section by listing any known allergies, identifying marks, special medical or dietary needs, and areas of concern.
  13. Finally, review the permissions and acknowledgments, then provide your signature as custodial parent or legal guardian along with the date to verify the accuracy of the information.
  14. Save your changes to the form, and feel free to download, print, or share it as needed.

Complete the enrollment process for your child online today!

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