Mom's Day Out Enrollment 2019-2020
Child's Name *
Your answer
Birthdate *
Your answer
Please list any food allergies, intolerances, or special needs I should know about
Your answer
Child's Name (2)
Your answer
Birthdate
Your answer
Please list any food allergies, intolerances, or special needs I should know about
Your answer
Which day are you registering for?
Mom's Name *
Your answer
Phone number *
Your answer
Email *
Your answer
Dad's Name *
Your answer
Phone number *
Your answer
Email
Your answer
Person(s) who will be dropping off and picking up. Please list name and phone number. *
Your answer
Is your child potty trained? *
How did you hear about Mom's Day Out?
If you were referred by a friend, who referred you?
Your answer
Do you give permission for your child's image to appear on the Mom's Day Out Facebook page and Mom's Day Out website? Give your permission by typing your name below. If you do not give your permission, please leave blank.
Your answer
Monthly Tuition
Tuition rates are as follows:
$90 per month for one child 9 am - 2 pm.

$170 per month for two children (siblings).


Because there is no registration fee, paying your monthly tuition ensures that your child has a spot for the upcoming month. Spots are reserved on a first pay, first served basis. Payment can be made via PayPal to amythayer@gmail.com, by check made out to Amy Thayer, or via Venmo @MomsDayOutUtahCounty. Once you complete this registration form, I will email you to arrange payment.

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