Registration Form CHILD INFORMATION Child’s Name: Nickname: Birth Date: Age: Sex: Male Feminine Address: City: State: Zip: PARENT INFORMATION Mother’s Name Email Address: City: Cell phone: Home Phone: Employer: Employer’s Address: Father’s Name: Email Address: City: Cell phone: Home Phone: Employer: Employer’s Address: Will your child have a sibling enrolled? Yes No If yes, give sibling’s first name and age Yes No Child’s Name: Age: Enrollment: Please return this completed form along with immunization records, payment for your child’s Registration and weekly fee to begin the enrollment process. Prior to your child’s attendance at The Little House Learning Center, all enrollment information must be completed, signed and returned to the office director. Send Now CHILDREN’S ENROLLMENT FORM Child’s Name: Nickname: Entrance Date Withdrawal Date Birth Date: Age: Sex: Male Feminine Home Address: City: State: Zip: PARENT INFORMATION Mother’s Name Email Address: City: Cell phone: Home Phone: Employer: Employer’s Address: Father’s Name: Email Address: City: Cell phone: Home Phone: Employer: Employer’s Address: Will your child have a sibling enrolled? Yes No If yes, give sibling’s first name and age Yes No Child’s Name: Age: Child’s Living Arrangement Check one Both Parents Mother Father Other Child’s Legal Guardian(s) Check one Both Parents Mother Father Other The child may be released to the person(s) singing this agreement or to the following: Name Address Telephone Number Relationship to child Relationship to Parent(s) or Guardian Other identifying information (if any) Name Address Telephone Number Address Relationship to child Relationship to Parent(s) or Guardian Other identifying information (if any) Persons to contact in the case of emergency when parent or guardian cannot be reached: Name Telephone Number Send Now Admissions team looks forward to learning about you and your family.
