Mighty Bambinis Prospective Family
Parent 1: Name *
Your answer
Parent 1: Email
Your answer
Parent 1: Employer / Occupation
Your answer
Parent 1: Phone
Your answer
Parent 2: Name
Your answer
Parent 2: Phone
Your answer
Parent 2: Email
Your answer
Parent 2: Employer / Occupation
Your answer
Child Name:
Your answer
Child Date of Birth:
MM
/
DD
/
YYYY
Age at Start (desired) of Care:
Your answer
Desired Start Date of Care:
MM
/
DD
/
YYYY
Probable End Date of Care:
MM
/
DD
/
YYYY
Program options *
Check all that apply
Required
Days of the Week
M/W/F and T/TH are the typical 2 and 3 day options, but we may be able to accommodate alternative schedules
What is your child's previous childcare experience?
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Describe your child's eating habits and family meal time routines
picky or loves to eat, favorite foods, least favorite, frequency, any other comments
Your answer
Describe your child's nap and night sleep routines including rituals, timing, and duration.
Your answer
What three words describe your child?
Your answer
Describe your child's experiences in social situations with peers 2-5 years old
Your answer
Describe your child's recent reactions when in a new childcare situation with a new caregiver or environment such as a gym drop in childcare, with a new sitter/friend, etc
Your answer
How do you handle behavioral concerns/situations at home?
Your answer
What are some factors impacting your decision to enroll in childcare?
Do you have any concerns about Mighty Bambinis meeting your needs?
Your answer
How did you hear about us?
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Have you submitted your application fee? *
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