Little Saints Child Registration
A separate registration form must be completed for each child. For any required fields that are not applicable to your child, please enter "N/A."

We are delighted to serve your family by providing after school care for your children!

Child's Name: *
Your answer
Nickname:
Your answer
Child's Date of Birth: *
MM
/
DD
/
YYYY
Gender: *
Primary Phone: *
Your answer
Address: *
Your answer
Please list any chronic physical problems/pertinent developmental information/ special accommodations needed (such as asthma, corrective lenses...etc):
Your answer
Please list any restrictions from activities:
Your answer
Previous Daycare Programs & Schools Attended: *
Your answer
Current School or Program (with days & hours): *
Your answer
Grade: *
Transportation: *
Next
Never submit passwords through Google Forms.
This form was created inside of Salem Christian School. Report Abuse - Terms of Service