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Registration Form

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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40 views1 page

Registration Form

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.

Uploaded by

api-297590185
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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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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