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Fill Out Your Daycare Form

The Daycare Registration Form is an essential document designed for parents looking to enroll their children in daycare at Westbrook Christian School. This form collects important information about your child, including personal, medical, and social details. Ensure a smooth registration by filling out the form completely; click the button below to get started.

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Article Structure

When enrolling a child in daycare, one of the most essential documents is the Daycare Registration Form. This comprehensive form collects detailed information about the child, from personal identification to crucial health and social factors. Parents begin by providing their child's name, age, and birthday, as well as important contact details like home addresses and phone numbers. This initial section ensures that the daycare has a solid foundation of basic information, which can be vital in case of emergencies. Additionally, parents must disclose their occupational details and marital status, including custody arrangements if applicable. The form also includes a section to list siblings, offering insight into the child’s family dynamics. Health is a significant focus. Parents must provide the name of their child’s physician and any medical history, including allergies and past illnesses. This information is invaluable for caregivers, ensuring that they can respond appropriately to any medical emergency. Moreover, the form delves into the child’s social habits, toilet training status, and daily routines, helping daycare staff better understand how to create a nurturing environment for each child. Furthermore, there’s a section dedicated to the family’s religious affiliation, allowing for a holistic understanding of the child's background. Lastly, parents will also find details regarding fees and pickup policies, highlighting the daycare's commitment to transparency. By thoroughly filling out this form, parents play a critical role in fostering a safe, supportive daycare experience tailored to their child’s unique needs.

Daycare Example

WESTBROOK CHRISTIAN SCHOOL

100 Westminster Drive

Rainbow City, AL 35906

(256)442-7457

www.westbrookchristian.org

DAYCARE REGISTRATION FORM

(3K & 4K)

============================================================================================

CHILD’S NAME:________________________________________________________________

PARENT(S):___________________________________________________________________

NAME CHILD GOES BY:______________________________ MALE FEMALE

(Circle one)

CHILD’S HOME ADDRESS:_______________________________________________________

Street Address/P.O. Box/Apartment Number

_______________________________________________________

City/State/Zip Code

TELEPHONE: (_____)________________________ SOCIAL SECURITY #:_______________

AGE OF CHILD:__________________________ BIRTHDAY: _________________________

MOTHER’S NAME:______________________________________________________________

HOME ADDRESS:______________________________________________________________

Street Address/P.O.Box/Apartment Number

______________________________________________________________

City/State/Zip Code

MOTHER’S OCCUPATION:______________________________________________________

TELEPHONE NUMBERS: Home: (_____)______________________________________

Work: (_____)______________Ext._________ Cell: (_____)__________________________

FATHER’S NAME:______________________________________________________________

HOME ADDRESS:______________________________________________________________

Street Address/P.O. Box/Apartment Number

______________________________________________________________

City/State/Zip Code

FATHER’S OCCUPATION:______________________________________________________

TELEPHONE NUMBERS: Home: (_____)______________________________________

Work: (_____)______________Ext._________ Cell: (_____)__________________________

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FAMILY

Give names and ages of your child’s siblings:

_____________________________________________________________________________

PARENTS’ MARITAL STATUS:	Married	Separated	Divorced	Widowed
			(Circle one)

If parents are separated, who has custody of the child? ________________________________

A copy of the most recently issued Court Order providing custody status must be on file with the school.

List persons approved to call for child (Child will not be released to others without specific permission from parents.):________________________________________________________

_____________________________________________________________________________

MEDICAL

NAME OF CHILD’S PHYSICIAN:___________________________________________________

PHYSICIAN’S TELEPHONE NUMBER: (_____)_______________________________________

Persons to be called in case of emergency if parents are unavailable:

NAME:_______________________________________________________________________

RELATIONSHIP:________________________ TELEPHONE: (_____)__________________

NAME:_______________________________________________________________________

RELATIONSHIP:________________________ TELEPHONE: (_____)__________________

Should my child, _____________________________________, become ill or suffer an accident

of any nature while in the care of Westbrook Christian School Daycare, Rainbow City, Alabama, the Preschool Director shall undertake to contact me immediately. In the event she is unable to reach me immediately, she will attempt to reach one of the above listed persons. Should this be impossible, the Director shall be authorized to secure and consent to such medical attention, treatment, and services for my child if given by me in person. I agree to assume the responsibility for payment of all medical costs incurred and not covered by the insurance.

Date:____________________ Parent(s) Signature:___________________________________

____________________________________

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Check any of the following your child has had:

_____Whooping Cough	_____Chicken Pox	_____Appendicitis
_____Measles	_____Diphtheria	_____Head injury
_____German Measles	_____Prolonged high fever	_____Asthma
_____Mumps	_____Tonsillitis	_____Acute ear infections
_____Hay Fever	_____Convulsions	_____Rheumatic Fever

_____Other____________________________________________________________________

What allergies does your child have? _______________________________________________

List other medical information that you feel might help us:________________________________

_____________________________________________________________________________

SOCIAL INFORMATION

Is this your child’s first separation from home? _______________________________________

Has your child had any kind of group experience? Describe:_____________________________

_____________________________________________________________________________

Does your child make new friends easily? ___________________________________________

Is your child toilet trained? ________________________________________________________

What special words does your child use to tell you he/she needs to urinate or have a bowel movement? __________________________________________________________________

What time does your child get up in the morning? ____________________________________

What time does your child go to bed at night? ________________________________________

Is your child accustomed to taking an afternoon nap? _______ For how long? ______________

Does your child have any special nap or bedtime routine? ______________________________

_____________________________________________________________________________

What time does your child usually have: Breakfast________ Lunch_________ Dinner________

Is your child accustomed to having between meal time snacks? __________________________

Does your child need any help feeding himself/herself? ________________________________

What fears does he/she have (such as animals, storms, etc.)?____________________________

_____________________________________________________________________________

How do you handle these fears? __________________________________________________

Other comments and special instructions: ___________________________________________

_____________________________________________________________________________

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RELIGIOUS AFFILIATION

What church do you attend?_______________________________________________________

Do you attend: Regularly_______ Occasionally_______ Seldom_______

Is your child enrolled in Sunday School? ____________________________________________

If not a church member, give a church preference: ____________________________________

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Westbrook Christian School

Daycare Contract

Please complete the following:

Child’s name: ______________________________________________

Days my child is enrolled in preschool:

Mon. Tues. Wed. Thurs. Fri.

Days daycare is needed:

Mon. Tues. Wed. Thurs. Fri.

Charges for daycare are as follows: $12.00 (includes lunch) 12:00-5:30

Late charge of $5.00 per every 2 minutes for pickup after 5:30 p.m.

I agree to pay Westbrook Christian School daycare with post-dated checks for the days I have enrolled my child in daycare. Daycare charges will apply even in the event that my child is unable to attend.

Parent’s signature: ____________________________________________

Date: _______________________________________________________

WESTBROOK CHRISTIAN SCHOOL

Child’s Medical Report – Daycare

CHILD’S NAME:__________________________________ DATE OF BIRTH:_______________

PARENT OR GUARDIAN’S NAME:_________________________________________________

HOME ADDRESS:______________________________________________________________

Street Address/P.O.Box/Apartment Number

______________________________________________________________

City/State/Zip Code

HOME TELEPHONE: (_____)_____________________________________________________

Attach Certificate of Immunizations (blue slip) for children age 4 years and older. If blue slip is not available or if child is 3 years of age and under, complete the section below.

IMMUNIZATIONS
Type of Immunizations		Number Given as of Date of
		this Examination
DTP or DT		____________
Polio		____________
Red Measles		____________
Rubella (German Measles)		____________
Mumps (Optional)		____________
Immunizations are up to date for age of child	Yes_______	No_______
Laboratory and other testings (if indicated):	Yes_______	No_______

History of Allergies:_____________________________________________________________

_____________________________________________________________________________

=========================================================================

I examined this child on this date _________________. I find him/her to be in good physical condition, free of contagious

and infectious diseases, and capable of participating in daycare activities, except as noted below.

DATE:________________ PHYSICIAN’S SIGNATURE:________________________________

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STATE OF ALABAMA

AFFIDAVIT FOR PARENT/GUARDIAN

COUNTY OF ETOWAH

Before me, a Notary Public in and for said State and County, appeared

________________________________________________________________

and is known to me, after being duly sworn or affirmed, says as follows:

The affiant is the parent or legal guardian of the minor child/children

_____________________________________: that affiant has been notified by

Sandra Handley, a representative of Westbrook Christian School, that said church or school has filed notice and is exempt under law from regulation by The Department of Human Resources.

____________________________________ parent/legal guardian sworn,

or affirmed to and subscribed before me this _______ day of _______________,

20_______.

________________________________

NOTARY PUBLIC

My Commission Expires:____________

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Westbrook Christian School

After-school Care Contract

5K – 6th

After-school care for 5K – 6th grade is set up on a contract system. Due to limited space, availability will be based on a first-come, first-serve basis. Therefore, the sooner we receive your completed contract—the better chance you will have of obtaining a place for your child(ren).

Please complete and return the following:

Child’s Name: ____________________________________________________

If enrolling more than one child, you may use one contract for all of your children as long as they are enrolled for the same time periods. If not, please complete a separate contract for each child.

Circle the days your child will need after-school care:

Monday

Tuesday

Wednesday

Thursday

Friday

Circle the hours your child will need after-school care:

2:30 p.m. – 3:30 p.m.

2:30 p.m. – 4:30 p.m.

2:30 p.m. – 5:30 p.m.

Cost is $3.00 per hour. After choosing the contract plan, bookkeeping will provide you with a list of cost per month based on the school calendar.

You are choosing between three contracts, which are set up to allow for pick-up any time during the time frame set by the selected contract. Your cost is based on the particular contract you select. If you are late picking up your child(ren) more than once, you will automatically be switched to the next contract.

Adjustments to your payments will be made at that time. There is a late fee of

$5.00 for every 2 minutes past 5:30 p.m.

I agree to pay Westbrook Christian School with post-dated checks (dated August, 2010 – May, 2011) for the hours I have enrolled my child(ren) in after-school care. These charges will apply even in the event my child is unable to attend.

Parent’s signature: __________________________________ Date: ________

Get Daycare PDF Form

Form Characteristics

Fact Name	Description
Location	Westbrook Christian School is located at 100 Westminster Drive, Rainbow City, AL 35906.
Contact Information	The school can be reached at (256) 442-7457 or through their website at www.westbrookchristian.org.
Age Range	This daycare registration form is designed for children aged 3K and 4K.
Emergency Contacts	Parents must provide emergency contacts in case they are unavailable during a child's illness or accident.
Medical Consent	Parents authorize the Preschool Director to seek medical attention if a child becomes ill or has an accident.
Fees	The daycare charges $12.00, which includes lunch, with specific late fees applied for late pickups.
Parent's Agreement	Parents agree to pay daycare fees with post-dated checks for the days their child is enrolled.
Parent Marital Status	The form requires parents to state their marital status, with options including Married, Separated, Divorced, and Widowed.
Religious Affiliation	Parents are asked to indicate their church affiliation and whether their child is enrolled in Sunday School.

Guidelines on Utilizing Daycare

Completing the Daycare Registration Form is an essential step in enrolling your child in Westbrook Christian School. Your information helps the school understand your child's needs and ensures a safe and nurturing environment. Here’s how to fill out the form step by step.

Child’s Information: Write your child's full name. Indicate the name they go by and check their gender.
Address: Fill in your child’s home address, including street, city, state, and zip code.
Contact Details: Provide the telephone number and your child’s social security number. Also, write their age and birthday.
Parent Information: Enter both parents' names and home addresses, if different. Include their occupations and telephone numbers (home, work, and cell).
Siblings: List the names and ages of any siblings your child has.
Marital Status: Circle the current marital status of parents. If separated, name the custodial parent and include a court order if necessary.
Emergency Contacts: List approved individuals who can pick up your child. Specify their names and relationships to your family.
Medical Information: Fill in your child's physician’s name and telephone number. Include emergency contacts if parents are unavailable.
Health History: Check any health issues your child has had and provide information about any allergies or important medical details.
Social Information: Answer questions about your child’s social habits, sleep routines, and any fears they may have.
Religious Affiliation: Indicate the church your family attends and your child’s Sunday School enrollment status.
Daycare Contract: Complete the section regarding the days your child will attend school and when daycare is needed. Agree to payment terms by signing and dating the form.

What You Should Know About This Form

What information is required to complete the Daycare Registration Form?

The Daycare Registration Form asks for various types of information to ensure the safety and well-being of your child. This includes the child’s name, age, and date of birth, as well as parental information such as names, contact numbers, and addresses. You will also provide emergency contact details, medical history, and any allergies your child may have. Completing this form accurately helps the daycare staff provide the best care possible.

How will my child’s medical information be used?

Your child's medical information is crucial for the daycare staff to respond effectively in case of an emergency. It helps them understand any health issues, allergies, or special considerations that may affect your child's care. The information will only be used for the purpose of ensuring your child's safety and well-being while in their care, and will be kept confidential.

What if my child becomes ill at daycare? Who will be contacted?

If your child becomes ill while at daycare, the Preschool Director will first attempt to contact you. If you are not reachable, the staff will try to reach one of the emergency contacts provided on the form. In situations where immediate medical attention is required and you are unavailable, the director has the authority to secure necessary medical services. It is vital to keep the emergency contact details updated so that the staff can act quickly and efficiently.

What are the costs associated with the daycare?

The daily charge for daycare is $12.00, which includes lunch. Parents are expected to make payments using post-dated checks for the enrolled days. Additionally, if you pick up your child after 5:30 p.m., a late fee of $5.00 will be applied for every two minutes beyond this time. It’s essential to be aware of these cost structures to plan accordingly for daycare expenses.

Common mistakes

Filling out a daycare registration form can seem straightforward, but many parents make common mistakes that can complicate the enrollment process. The first mistake often involves incomplete or unclear information. Parents sometimes skip vital fields, such as the emergency contact details or medical history. Incomplete sections can delay the registration process and hinder the daycare staff's ability to respond effectively in emergencies.

Another common error is mixing up the child's name with the name they usually go by. It is essential to clarify the child’s full legal name and the preferred name. Confusion can arise if the names differ significantly. It is advisable to double-check the spelling and ensure all name-related fields are filled out accurately.

Additionally, incorrect contact information can create significant challenges. If a parent lists their phone number incorrectly, the daycare may struggle to reach them in case of emergencies. Parents should take care to verify that the area codes and numbers are accurate, and it’s helpful to format them consistently.

Lastly, failing to provide medical history can be detrimental for the child's well-being. Parents sometimes do not list allergies or prior medical conditions, believing those details might not be important. However, this information is critical for the daycare staff to ensure the health and safety of all children in their care. It is crucial to be thorough in detailing any medical concerns.

Documents used along the form

In addition to the Daycare Registration Form, several other documents and forms are typically required for enrollment and operation within a daycare setting. Each of these documents addresses specific responsibilities, information, or policies related to childcare and the welfare of the children. Below is a list of these forms and a brief description of their purposes.

Daycare Contract: Outlines the terms and conditions of daycare services, including fees, hours, and obligations of both the parents and the daycare provider.
Emergency Contact Form: A document that provides critical contact information in case of an emergency, ensuring that the daycare can reach family members or designated contacts when necessary.
Health History Form: Collects information about the child’s medical history, allergies, past illnesses, and current medications, which is essential for the care and safety of each child.
Authorization for Emergency Medical Treatment: Grants the daycare permission to seek emergency medical attention for the child if the parents are unavailable and provides necessary medical information.
Immunization Records: Provides proof that the child has received the required vaccinations, which is often mandatory for enrollment in a daycare facility.
Parent Handbook Acknowledgment: Confirms that parents have received and read the parent handbook, which often details daycare policies, procedures, and expectations.
Field Trip Permission Slip: Authorizes the child to participate in off-campus activities organized by the daycare, ensuring parents are informed and consent to their child's involvement.

These documents work together to ensure a safe and structured environment for children in daycare. They facilitate communication between parents and providers, helping to create a foundation for a positive childcare experience.

Similar forms

Child Enrollment Form: Similar to the Daycare form, this document collects essential information about the child and parents, including names and contact details. It helps institutions keep accurate records of enrolled children.
Emergency Contact Form: Like the Daycare form, this document identifies individuals who can be contacted in case of an emergency. It ensures that the institution knows whom to reach if parents are unavailable.
Medical History Form: This form often includes sections on the child’s medical background, allergies, and current medications, paralleling the medical information request in the Daycare form.
Childcare Agreement: This document outlines the terms of care provided, including fees and rules, similar to the contractual aspect found in the Daycare form where daycare charges and payment agreements are stated.
Consent for Medical Treatment Form: This document grants permission for medical care in emergencies, reflecting the parental consent language present in the Daycare form regarding medical decisions.
Behavioral Assessment Form: This form collects information about a child’s social behavior and interactions, akin to the social information section in the Daycare form asking about the child’s experience in group settings.
Registration Form for Extracurricular Activities: Similar in structure, this form gathers information from parents to enroll their child in activities outside daycare, ensuring all necessary data is on file.
Health History Questionnaire: This document requests detailed information about the child’s health, echoing the medical inquiries made in the Daycare form.
Transportation Permission Form: Like the Daycare form, this document allows parents to authorize transportation for their child, ensuring safety and accountability.
Parent Feedback Form: Used to gauge parental satisfaction and needs, this form is similar in purpose to the comments section of the Daycare form, where parents can provide additional information and suggestions.

Dos and Don'ts

When filling out the Westbrook Christian School Daycare registration form, certain practices can help ensure that all necessary information is accurately submitted. Below is a list of things to do and avoid during this process.

Do double-check all fields for accuracy before submission.
Do provide complete and current contact information for both parents.
Do indicate any special medical needs or allergies your child may have.
Do list approved persons who can pick up your child, and ensure they are aware of their status.
Do specify your child’s religious affiliation and church attendance, if applicable.
Don't leave any sections blank—missing information can delay registration.
Don't embellish or provide inaccurate information regarding your child’s health or abilities.

Filling out the daycare form carefully will facilitate a smoother enrollment process and ensure the wellbeing of your child in daycare. Keep this list close to guide you while you complete the form.

Misconceptions

Understanding the Daycare Registration Form is essential for parents enrolling their children in daycare. Yet, several misconceptions often arise. Here are some common misunderstandings and the truths behind them:

Misconception 1: The form is only for new enrollments.

Many believe that the daycare form is solely for new students. However, it also needs to be updated annually for returning families to keep health and contact information current.

Misconception 2: I don't need to provide any medical history.

Some parents think providing detailed medical history is optional. In reality, it is crucial for the daycare to know any allergies or medical conditions to ensure the child’s safety and well-being.

Misconception 3: The daycare will handle all emergencies without my input.

While staff are trained to handle situations, parents must indicate emergency contacts. This ensures that the daycare can make informed decisions if parents are unavailable.

Misconception 4: Filling out the form is a simple task; it doesn't require much thought.

Completing the form thoughtfully is vital. Accurate and comprehensive information helps daycare providers better understand the child, ultimately creating a more nurturing environment.

Misconception 5: Financial responsibility is not a concern until later.

Many assume financial obligations come after enrollment. Parents should be aware that they are signing an agreement to pay regardless of attendance, so reviewing the fee structure in advance is essential.

Misconception 6: Information about siblings isn't essential.

Parents might overlook the section about siblings. However, knowing about siblings can give caregivers insight into the child’s social context and support needed during their time at daycare.

Misconception 7: The form is just a formality; it won’t affect my child’s experience.

This thought can lead to negligence in filling out the form. In reality, the information collected shapes the caregiving approach and helps create suitable activities that align with the child’s needs.

Clearing these misconceptions empowers parents to provide accurate and valuable information on the daycare form, enhancing their child's experience while in daycare.

Key takeaways

1. Provide Accurate Information: Ensure that all sections of the Daycare form are filled out completely and accurately. This includes your child's personal information, contact details, and medical history. Flaws or omissions can delay enrollment or cause issues in emergencies.

2. Keep Emergency Contacts Updated: Include names and contact numbers for individuals who can be reached in case of emergencies. Ensure that this information is current and that those individuals are aware they are listed as contacts.

3. Understand Financial Responsibilities: Be aware that daycare charges apply for every day your child is enrolled, regardless of attendance. Timely payment is essential to avoid additional late fees. Payment should be made using post-dated checks.

4. Share Relevant Medical and Behavioral Insights: Provide detailed information about any medical conditions, allergies, or behavioral concerns your child may have. This will aid caregivers in providing the best possible care and support for your child.

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