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Registration Form/Waiting List: Days/Hours of Care Desired

A $50 non-refundable registration fee is required to place a child on the waiting list for Great Expectations Child Care. The registration form requests information such as the child's name, age, date of birth, desired start date, and preferred days and hours of care. It also collects contact information for the parents/guardians including address, phone number, email, place of employment, and social security number. By signing the contract agreement, parents agree to abide by center policies including payment of tuition, early drop-off/late pick-up fees, a two week notice for termination, and hourly charges for care over 10 hours per day.

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57 views1 page

Registration Form/Waiting List: Days/Hours of Care Desired

A $50 non-refundable registration fee is required to place a child on the waiting list for Great Expectations Child Care. The registration form requests information such as the child's name, age, date of birth, desired start date, and preferred days and hours of care. It also collects contact information for the parents/guardians including address, phone number, email, place of employment, and social security number. By signing the contract agreement, parents agree to abide by center policies including payment of tuition, early drop-off/late pick-up fees, a two week notice for termination, and hourly charges for care over 10 hours per day.

Uploaded by

geelc_2004
Copyright
© Attribution Non-Commercial (BY-NC)
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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690 Johnson Street

Watertown, WI 53094
(920)262-3588
Fax (920)262-3589
Email [email protected]

Registration Form/Waiting List

A $50.00 non-refundable fee for each family is to be paid at the time of registration.
Name of Child
________________________________________________________________
Age of Child ___________________________________________________________________
Date of Birth _________________________________________________________________
Desired Start Date ___________________________________________________________________
Days/Hours of Care Desired:
Monday

Tuesday

Wednesday

Thursday

Friday

___ to ___

___to___

___to___

___to___

___to___

Parent/Guardian Name ______________________________________________________________


Address _______________________________________________________________
Phone Number _______________________________________________________________
Email Address ________________ ________________________________________________
Place of Employment & Phone Number_________________________________________
Social Security Number _______________________________________________________
Parent/Guardian Name ______________________________________________________________
Address _______________________________________________________________
Phone Number _______________________________________________________________
Email Address ________________ ________________________________________________
Place of Employment & Phone Number_________________________________________
Social Security Number _______________________________________________________
Has child been in Child Care before? Y or N
How did you learn about Great Expectations?
If referred, name of referral

Internet

Phone Book

Referral

Contract Agreement:

I agree to abide by all center policies, explained further in the Family Handbook. This includes
tuition payment, early drop-off / late pick-up and absence policies. I understand Great
Expectations requires a two week written notice before terminating enrollment and that I am
responsible for payment of these two weeks regardless of attendance. Any scheduled hours of
attendance over 10 hours per day will result in hourly charges up to a maximum of 12 hours of care
per day, per state regulations. I understand all registration, enrollment and tuition fees are nonrefundable. Failure to follow center policies may result in termination of enrollment.

Parent Signature

Date

----------------------------------------------------------------------------------------------------------Office use only

Fee Paid
___cash
Date & Initials

___check #_________
Enrollment Starts ___________________

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