Enrollment Application - Infant and Toddler

safe n sound playground

Preschool & daycare

Child's Name (First and Last): *

Describe your child’s prior experience in a childcare setting:

Parent(s) Full Name: *

DOB/Due Date:

We are excited that you are interested in our center! Please fill out this form and send it back to be placed on the waitlist. Once we receive the completed form, we will put you on the waitlist and review our enrollment openings. When there is an opening in your child’s age group, we will contact you to schedule a tour of the center and give you an enrollment packet. Thank you!

Is there anything in the child’s personal life or home environment that would affect their enrollment at our facility (custody, living situation, visitations, etc.):

Is your child up to date on immunizations? (We are a fully immunized center, so we cannot take exemptions) *

Yes

Preferred Contact Number:

Email: *

If Part-time, what days will your child attend?

Start Date Needed:

Any additional information that would be helpful in the care of your child:

Describe any physical, developmental or behavioral concerns you or your child’s pediatrician might have:

Enrollment:

Full-Time (M-F)

Part Time (3 Set Days/Week)