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About Us
Programs
Children
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Adults
Counseling
News
Our Products
Projects
Get Involved
Careers
Volunteers
Contact Us
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Nursery
Registration
Form
"
*
" indicates required fields
Child Information
Child's Full Name:
*
Date of Birth:
*
MM slash DD slash YYYY
Gender:
*
Male
Female
Address:
*
Nationality:
*
Primary Language Spoken at Home:
*
Parent/Guardian Information 1
Full Name:
*
Relationship to Child:
*
Address (if different):
*
Phone Number (Mobile):
*
Email Address:
*
Occupation:
*
Employer:
*
Parent/Guardian Information 2
Full Name:
*
Relationship to Child:
*
Address (if different):
Phone Number (Mobile):
*
Email Address:
*
Occupation:
*
Employer:
*
Emergency Contact Information (Other than Parents/Guardians):
Full Name:
*
Relationship to Child:
*
Phone Number:
*
Address:
*
Nursery Program Information
Desired Start Date
*
MM slash DD slash YYYY
Program Preference
*
Full-time (8:00 am- 4:00 pm)
Part-time (3 days a week)
Extra hour 4:00 pm- 5:00 pm
Any specific needs or requests:
*
I give permission for my child to participate in nursery activities, including outdoor play
*
Yes
NO
I give permission for the nursery to administer basic first aid to my child
*
Yes
NO
I give permission for the nursery to use my child's photograph or video for internal nursery purposes (e.g., website, newsletter)
*
Yes
NO
Child's Health Information
Allergies: Please list any known allergies to food, medication, or environmental factors.
*
Chronic Conditions: Please list any chronic health conditions, such as asthma, diabetes, or heart problems.
*
Medications: Please list any medications your child is currently taking, including dosage and frequency.
*
Immunizations: Please provide a copy of your child's immunization record.
*
Max. file size: 4 GB.
Unique requirements: Please indicate if your child has any special requirements, such as learning or behavioral challenges.
Max. file size: 4 GB.
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Date:
MM slash DD slash YYYY
Parent/Guardian Signature:
*
