Sturgis Childcare Center Registration 2018-19
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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