Registration Form — Treefort Drop In Hourly Child Care

Begin your registration today!

Please fill out the following information and we will get you registered in Brightwheel as soon as possible (Our app to communicate daily reports on your child(ren), manage check in/check out, and database for family records).

Or complete registration during the first drop off.

There is a $40 annual family registration fee. We also require all children to be immunized, there are no exemptions.

Enrollment Date

YYYY

Parent Information

Parent/Guardian Name (primary)

First Name

Last Name

Parent/Guardian Phone (primary)

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email (primary)

Parent's Employer's Name (primary)

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone

(###)

###

####

Parent's Employer's Name

Child(ren) Information

Child's Name

First Name

Last Name

Child's Birthday

YYYY

Child's Name

First Name

Last Name

Child's Birthday

YYYY

Child's Name

First Name

Last Name

Child's Birthday

YYYY

Child's Name

First Name

Last Name

Child's Birthday

YYYY

Emergency Contact (other than parent)

Emergency Contact Phone Number

Allergies/Medications/Notes

Primary Doctor Name

Primary Doctor Phone Number

Primary Doctor Address

Consent to Treat

In the event that I cannot be reached, I give my consent for Treefort Drop In Child Care to contact "Primary Doctor Name" (listed above) at "Primary Doctor Phone Number" (listed above) and if necessary, take my child to the "Preferred Hospital" (listed above).

Yes

Preferred Hospital

How did you hear about us?

Photo Release

I give Treefort Drop In Hourly Child Care staff to photograph my children while at the center, field trips or other Treefort events. I understand that these photographs may be used to promote childcare services in print, or online and that no names will be shared with the photo.

Yes

Begin your registration today!

Days and Hours:

Address:

Phone:

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