Pre-Registration for Child Care
Registration for child care of school age children
Email address *
BASD~ Child Care Program
Name of Center *
Child's Name *
Your answer
Address *
Your answer
Mother's Name/Legal Guardian *
Your answer
Address *
Your answer
Phone number
Your answer
Email *
Your answer
Business Phone number & extension
Your answer
Father's Name/Legal Guardian *
Your answer
Address *
Your answer
Phone number
Your answer
Email *
Your answer
Medical or Dietary Information Necessary in an Emergency Situation *
Your answer
Additional Information on Special Needs of Child (motion sickness, seizures) *
Your answer
Allergies (Including Medication Reaction) *
Your answer
Medication, Special Conditions
Your answer
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