Day Care Registration Form - vishwanathhomelykids.com

Child’s Full Name

Please enter the child’s full name.

This field is required.

Parent/Guardian’s Name

Enter the full name of the parent or guardian.

This field is required.

Contact Number

Provide a contact number where we can reach you.

This field is required.

Email Address

Enter your email address for important updates.

This field is required.

Emergency Contact Name

Name of a person we can contact in case of emergency.

This field is required.

Emergency Contact Number

Provide a contact number for emergency situations.

This field is required.

Address

Enter your residential address.

Address Line 1

This field is required.

Address Line 2

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City

This field is required.

State

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Postal Code

This field is required.

Country

Allergies or Special Needs

List any allergies or special needs your child has.

Pick-up Authorization Names

Names of people authorized to pick up your child.

Agreement to Terms and Conditions

I agree to the terms and conditions of the daycare.

This field is required.