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    This document is a registration form for Little Genius Academy. It collects information such as the child's name, date of birth, allergies, and emergency contact. It also requests the parents' contact information, including address, phone numbers, place of employment, and email. The form acknowledges receipt of the parent handbook and agreement to the center's policies. Finally, it asks the preferred enrollment schedule and payment details.

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    This document is a registration form for Little Genius Academy. It collects information such as the child's name, date of birth, allergies, and emergency contact. It also requests the parents' contact information, including address, phone numbers, place of employment, and email. The form acknowledges receipt of the parent handbook and agreement to the center's policies. Finally, it asks the preferred enrollment schedule and payment details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    22 views1 page

    Registration Form

    Uploaded by

    api-297590185
    This document is a registration form for Little Genius Academy. It collects information such as the child's name, date of birth, allergies, and emergency contact. It also requests the parents' contact information, including address, phone numbers, place of employment, and email. The form acknowledges receipt of the parent handbook and agreement to the center's policies. Finally, it asks the preferred enrollment schedule and payment details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    Little Genius Academy Registration Form

    First
    Last
    Childs Name:__________________________
    ___________________________
    Childs Date of Birth:_____/___/________Date Enrollment Begins:____/____/________
    Name of Childs Class:_____________________________________________________
    In Case of Emergency:_____________________________________________________
    Allergies:_____________________________________________EpiPen_____Y_____N
    Dietary Restrictions/ Requests:______________________________________________
    Pediatrician:___________________________________Phone #___________________
    Parents Security Password__________________________________________________
    Mothers Name_______________________________SS #________________________
    Home #____________________Work__________________Cell___________________
    Street Address____________________________________________________________
    City_________________________State__________Zip Code______________________
    Place of Employment______________________________email____________________
    Fathers Name_________________________________SS#_______________________
    Home #____________________Work__________________Cell___________________
    Street Address (Only if Different)_____________________________________________
    City_______________________________State_________Zip Code_________________
    Place of Employment______________________________email____________________
    I___________________________acknoweledge that Little Genius Academy has
    provided me with a Parents Handbook which includes the New Jerseys Child Care
    Center licensing requirements. I am also acknowledging and agree to the center illness
    policy and anything that I do not understand can be referenced in The Manual of
    requirements for Child Care Centers.
    Hours and Days Preferred: Please Check
    Five Day Full 8:00am-6:00pm______Five Day Part 8:30am-3:00pm_______
    Five Day Morning 8:30am-11:30am_________
    Three Full Day 8:00am-6:00pm________Three Day 8:30am-3:00pm________
    Three Morning 8:30am-11:30am________
    Please Circle What Days Preferred
    Monday Tuesday Wednesday
    Thursday
    Friday
    Two Full Day 8:00am-6:00pm_______Two Part Day 8:30am-3:00pm_________
    Two Morning 8:30am-11:30pm________
    Please Circle What Days Preferred
    Monday
    Tuesday
    Wednesday
    Thursday
    Friday

    Early Drop off 6:30am-8:00am________Late Pick Up 6:00pm-6:30pm_________


    Lunch Fee__________ Please Circle M T W TH F
    Registration Fee__________ Enrollment Fee____________
    Tuition_____________Total_____________
    Email address for billing____________________________________________________
    Parent/Guardian Signature________________________________________Date__________

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