In GOD’S Hands

ENROLLMENT FORM

Child’s Information

(Please complete a separate form for each child)

A $25.00 Registration fee must accompany the enrollment form  

All fees are non-refundable

Admission Date:                          

Are you enrolling for: Pre-School              Child Day Care (Toddler Program) _____  

Before School Care ___ After School care ___Before & After care___ Summer Program         

Child’s Name:                                                  Date of Enrollment:                              

Child’s Address:                                                                                                                      

City, State, Zip Code:                                                                                                              

Date of Birth:                                         Phone Number:                                                          

List the school that your child attends if applicable:                                                                   

School bus service:                                                                                                                        

Method of payment: Money Order       Voucher             Check

Parent’s Information

Father’s Name:                                                  Mother’s Name:                                     

Address:                                                            Address:                                                          

Phone Number:                                                  Phone Number:                                                

Work Number:                                                  Work Number:                                                

Work Address:                                                  Work Address:                                                

Contacts

In case of an emergency contact:

Name:                                                                                                                                     

Phone Number:                                                  Work Number:                                                

Alternate Name:                                                                                                             

Phone Number:                                                  Work Number:                                                

Drop Off and Pick Up

Name person(s) dropping off and picking up your child at the center:

Phone Number:                                                

Alternate Person:                                                  Phone Number:                                              

Drop off Time:              Pick up Time:                      

Name of the person who will be picking up your child form the center:                                              Phone Number:                                    (Use back if needed)