Child Care Registration Form
Thank you for considering Petit Scholars@RIA to fulfill your childcare needs. We want your child to explore, imagine and create with us!
Email address *
Campus
Child's Name *
Last, First Middle Initial
Your answer
Birthdate
MM
/
DD
/
YYYY
Child's Parent/Guardian Name *
Last, First Middle Initial
Your answer
Child's Parent/Guardian Name *
Last, First Middle Initial
Your answer
Alternate Email
Please provide the email address for the parent that is NOT completing the form.
Your answer
Home Address *
Your answer
Home Phone# *
Your answer
Altenative #1 *
Your answer
Alternative #2 *
Your answer
Anticipated Start Date *
We recognize that this may be a tentative start date.
MM
/
DD
/
YYYY
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