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For the Nations DC English Classes,
Fairfax
Childcare Registration Form - Fall 2024
Please fill out 1 form for each child you will bring with you.
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* Indicates required question
Adult Student First Name
*
Your answer
Adult Student Last Name
*
Your answer
Adult Student Relationship to child (Example: Mother, Father, etc.)
*
Your answer
Adult Phone Number
*
Your answer
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Child's Gender
*
Male
Female
Child's Age
*
Your answer
Child's Birthday. Please list the month, day, and year. (Example: June 1, 2020)
*
Your answer
Please list any food that your child is allergic to (makes your child sick). If your child does not have food allergies, put NONE. We do not serve any meat or gelatin in our childcare area.
*
Your answer
Does your child wear diapers or can they use the toilet?
*
diapers
toilet
If your child wears diapers, what size diaper do they wear?
1
2
3
4
5
6
Pull Up
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Please list any other information that is important to know about your child. (For example, please tell us if you are breastfeeding or if your child eats or takes a nap at a specific time.)
Your answer
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