Sturgis Childcare Center Registration 2016-17
Child's First Name
Your answer
Child's Middle Initial
Your answer
Child's Last Name
Your answer
Child's Birthdate
MM
/
DD
/
YYYY
Child's Sex
Required
Mother's Name
Your answer
Mother's Address (Please include City, State and Zip)
Your answer
Mother's Phone number
Your answer
Mother's Alternate Phone number
Your answer
Mother's email Address
Your answer
Father's Name
Your answer
Father's Address (Please include City, State and Zip)
Your answer
Father's Phone number
Your answer
Father's Alternate Phone number
Your answer
Father's email Address
Your answer
Child's Desired Start Date
MM
/
DD
/
YYYY
My child will attend on the following days of the week:
Required
My child's expected drop off time will be (please specify if expected drop off time will be different for different days of the week):
Your answer
My child's expected pick up time will be (please specify if expected pick up time will be different for different days of the week):
Your answer
I understand and accept that in addition to this registration form I still have to fill out the Childcare Enrollment Packet. The Childcare Enrollment Packet is picked up in person at our office located at 107 W West St.
Required
I understand and accept that there will be a $35 registration fee when I pick up the Childcare Enrollment Packet.
Required
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