Annual Registration

Step 1 of 6

GETTING ACQUAINTED RECORD

Please fill out one per child

My name is(Required)

First Last

I have ____ brothers

I have ____ sisters

Their names and ages are:

My favorite activity is:

My favorite food is:

My least favorite food is:

I am afraid of:

My favorite color is:

Parents:

Why are you looking for a new childcare arrangement?(Required)

Has your child had previous childcare experience?(Required)

Please list prior caregivers and/or childcare centers:(Required)

Describe this experience:

What type of discipline is used at home?(Required)

Does your child eat unaided?(Required)

Does your child enjoy eating?(Required)

Does your child have a special diet?(Required)

Due to your child's allergies and/or religious beliefs, are there any foods which should not be served to your child?(Required)

Is your child potty trained?(Required)

How does your child go to sleep?(Required)

What is the usual time and length of naps taken each day?(Required)

How long does your child usually sleep at night?(Required)

Please list any personal habits (thumb sucking, nail biting, etc.)(Required)

What are your main expectations of this program this year?(Required)

GETTING ACQUAINTED RECORD (Add Another Child)

Child #2

My name is

First Last

I have ____ brothers

I have ____ sisters

Their names and ages are:

My favorite activity is:

My favorite food is:

My least favorite food is:

I am afraid of:

My favorite color is:

Parents:

Why are you looking for a new childcare arrangement?

Has your child had previous childcare experience?

Please list prior caregivers and/or childcare centers:

Describe this experience:

What type of discipline is used at home?

Does your child eat unaided?

Does your child enjoy eating?

Does your child have a special diet?

Due to your child's allergies and/or religious beliefs, are there any foods which should not be served to your child?

Is your child potty trained?

How does your child go to sleep?

What is the usual time and length of naps taken each day?

How long does your child usually sleep at night?

Please list any personal habits (thumb sucking, nail biting, etc.)

What are your main expectations of this program?

Tuition Express

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT and CREDIT CARD

Consent(Required)

I (we) hereby authorize Here We Grow Early Learning Center to initiate credit card charges to the below-referenced credit card account (Section A) OR, initiate debit entries to my (our) checking or savings account, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. initial* Credit union members: please contact your credit union to verify account and routing numbers for automatic payments. Check with the center for accepted credit card types.(Required)

COMPLETE ONE SECTION ONLY (A OR B)

SECTION A (Credit Card)

Cardholder Name

Phone Number

Address

Street Address City State ZIP Code

Account Number

Expiration Date

Cardholder Signature

Date

SECTION B (Bank Account)

Your Name

Phone Number

Address

Street Address City State ZIP Code

Bank or Credit Union Name

Bank or Credit Union Address

Street Address City State ZIP Code

Routing Transit Number

Account Number

Checking / Savings

Checking

Savings

Authorised Signature

Date

Annual Registration

PARENT/GUARDIAN INFORMATION

CHILD INFORMATION

CHILD HEALTH ASSESSMENT

Does your child have any known allergies or sensitivities to:

Illnesses or Medical Conditions

CHILD #2 INFORMATION

CHILD HEALTH ASSESSMENT

Does your child have any known allergies or sensitivities to:

Illnesses or Medical Conditions

CONSENT TO MEDICAL CARE AND TREATMENT OF MINOR CHILDREN

EMERGENCY CONTACTS & AUTHORIZED PICK UP

Person 1

Person 2

Person 3

TUITION/PAYMENT INFORMATION

GETTING ACQUAINTED RECORD

Parents:

GETTING ACQUAINTED RECORD (Add Another Child)

Parents:

CONTRACT AND POLICY AGREEMENT

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT and CREDIT CARD

COMPLETE ONE SECTION ONLY (A OR B)

SECTION A (Credit Card)

SECTION B (Bank Account)

Have Questions?