CDC Registration

Please call for an appointment to visit our day care facility, you may also fill out a registration at the school.
Begin date:
Number of days*:5 days4 days3 days2 daysdrop in only
Name of child*:
Father*:
Address, City, State, Zip*:
Father phone*:
Place of business*:
Work phone*:
Mother*:
Address, City, State, Zip*:
Mother phone*:
Place of business*:
Work phone*:
Father home church*:
Mothers home church*:
Doctors name & phone*:
Dentist name & phone*:
Who to call in emergency*:
Emergency call 2 *:
Emergency call 3*:
Is child baptized?*:YesNo
Date baptized:
Does your child attend church?*:yesNo
Does your child attend Sunday School?*:yesno
Do you give your permission for your child to be photographed while at school?*:YesNo
If yes, do we have your permission to put your child on our web page?*:yesno
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