Childcare Registration Interest Form

Please complete the Childcare Interest Form below. A member of our team will review it and be in touch with you shortly. If you have more than two children to enroll in the program, please complete the form more than once.

If you have an immediate need, please contact our office at 480.813.2796

You can also download a Childcare Registration Interest Form and delivery a copy to our office.

Completion of the Interest form does not guarantee enrollment.

PARENT/GUARDIAN INFORMATION

Parent's Name

First Name

Last Name

Parents Email Address

Parent's Name 2

Parent's Email Address 2

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

FIRST CHILD

Child's Full Name

Date of Birth

YYYY

Age

Gender

Schedule

Full-Time (More than 5 hours per day)

Part-Time (Less than 5 hours per day)

Childcare Room

Days Needed

Example: Monday - Friday or Tuesday/Thursday

Times Needed

Example: 7:00am-4:00pm or 8:00am-5:30pm or 12:00pm-4:00pm

Preferred Start Date

YYYY

Is your child potty-trained?

Medical Conditions/Health Related Needs

Are there any specific ways we can help your child developmentally?

SECOND CHILD (If Applicable)

Child's Full Name

Date of Birth

Age

Gender

Schedule

Full-Time (More than 5 hours per day)

Part-Time (Less than 5 hours per day)

Days Needed

(Example: Monday - Friday or Tuesday/Thursday

Times Needed

Example: 7:00-4:00am or 8:00am-5:30pm or 12:00pm-4:00pm

Preferred Start Date

YYYY

Is your child potty-trained?

Medical Conditions/Health Related Needs

Are there any specific ways we can help your child developmentally?

Childcare Registration Interest Form

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