Apply for Admission | Redeemer Kids Development Center

Daycare and Child Care Enrollment Form

Child Bio

Child Information

Child's First Name * Child's Last Name * Date of Birth * Gender * Home Address *

(*) Mandatory

Parent/Guardian

Personal Information

First Name * Last Name * Relationship to Child * Phone (Mobile) * Phone (Home/Work) * Email * Address (if different) *

Secondary Parent/Guardian (Optional)

First Name Last Name Relationship to Child Phone (Mobile) Phone (Home/Work) Email Address (if different)

(*) Mandatory

Emergency Contacts

Contact One

Must be available during daycare hours and authorized to pick up the child

First Name * Last Name * Relationship to Child * Phone *

Contact Two

Must be available during daycare hours and authorized to pick up the child

First Name * Last Name * Relationship to Child * Phone *

(*) Mandatory

Pickup List

People allowed to pick up your child besides parents and emergency contacts

First Name * Last Name * Relationship to Child * Phone (Mobile) * Address *

Pickup Contact Two

First Name * Last Name * Relationship to Child * Phone (Mobile) * Address *

(*) Mandatory

Medical

Medical Information

Family Doctor * Clinic Phone * Health Card Number * Immunizations Up to Date? * Allergies * Medical Conditions / Special Needs * Medications Taken Regularly *

(*) Mandatory

Program Selection

Program Information

Program Type * Requested Start Date * Days Needed *

(*) Mandatory

Permissions / Consent

Consentual Agreement

Please check each *

(*) Mandatory

Fees Agreement

I understand that *

(*) Mandatory

Policies Acknowledgement

Policies Agreement

I acknowledge that I have received, read, and agree to RKDC�s: Parents / Guardian Initials *

(*) Mandatory

Signatures

Parent / Guardian Signatures

Parents / Guardian Signature * Date * Parents / Guardian Signature * Date * RKDC Staff Signature * Date *

(*) Mandatory

Student Application

Daycare and Child Care Enrollment Form

Child Bio

Child Information

Parent/Guardian

Personal Information

Secondary Parent/Guardian (Optional)

Emergency Contacts

Contact One

Contact Two

Pickup List

People allowed to pick up your child besides parents and emergency contacts

Pickup Contact Two

Medical

Medical Information

Program Selection

Program Information

Permissions / Consent

Consentual Agreement

Fees Agreement

Fees Agreement

Policies Acknowledgement

Policies Agreement

Signatures

Parent / Guardian Signatures

Quick links

Contact Us