What is your daycare center's philosophy?

Our daycare center believes in providing a nurturing and educational environment where children can learn, play, and grow together.

Is your staff trained and certified?

Yes, our staff members are highly trained and certified in early childhood education and first aid.

What activities do you offer for children?

We provide a wide range of age-appropriate activities, including arts and crafts, outdoor play, storytime, music, and more.

What is your approach to discipline?

Our discipline approach focuses on positive reinforcement and teaching children appropriate behavior through guidance and communication.

How do you communicate with parents about their child's progress?

We maintain open communication with parents through regular updates, parent-teacher conferences.

Daycare Enrollment

In accordance with New York State regulations

Child’s Name*

Child’s Nick Name*

Date of birth*

Gender*

Home Address (Street)*

Name Of person to Enrolling Child*

Phone Of person to Enrolling Child*

Email*

Address (If different than child)

Relationship To Child

Parents Gaurdian Caretaker Relative Other

Emergency Info

Authorize To Pickup	Primary Number	Other Number
Yes No	Ok to text	Ok to text
Yes No	Ok to text	Ok to text
Yes No	Ok to text	Ok to text

Entrance Date

Withdrawal Date

Check boxes below to indicate if your child has any special needs/services

Early Intervention/Special Education Occupational Therapy Speech/Language Physical Therapy None Other

Physical Therapy 1 Allergies (list)

Please provide information here AND discuss with your child care provider

Child's Primary Care Physician's Name/ Group

Phone Number

Preferred Hospital

Phone Number

Child's Dental Care

Phone Number

AGREEMENTS

I consent to emergency medical treatment for my child

Yes No

I consent for my child to take part in neighborhood trips (i.e., library, park and playground) away from the under proper supervision.

Yes No

I understand the program may need additional permissions for situations such as transportation, medication, release of information, and field trips.

Yes No

I provided information on my child's special needs to the program to assist in caring for my child.

Yes No

I understand the program must give parents, at the time of enrollment of a child, a written policy statement as required by regulation.

Yes No

I agree to review and update this information whenever a change occurs and at least once every year

Yes No

Child's Parent Signature

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