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Carebear Playhouse Enrichment Program Enrollment
Please complete this form to enroll your child in one of our fun and enriching programs.
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Email
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Your email
SECTION 1: Parent/Guardian Information
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Parent/Guardian Full Name
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Primary Phone Number
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Email Address
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SECTION 2: Child Information
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Child's Full Name
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Child's Age (in years)
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Allergies or Medical Notes (Please specify any conditions or medications)
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SECTION 3: Emergency Contact Information (Other than Parent/Guardian)
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Emergency Contact Full Name
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Emergency Contact Phone Number
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SECTION 4: Program Selection
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Option 1
Preferred Days of the Week
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Time Slot (e.g., Morning, Afternoon, Specific Time)
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SECTION 5: Required Acknowledgment and Agreement
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Acknowledgment of Program Status
*
I understand Carebear Playhouse provides instructor-led enrichment programs and is not a licensed childcare facility. I retain full responsibility for my child.
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