Enrollment

Student Information

Date of Birth

Sex

Male

Female

Date of Enrollment

First Name

Last Name

Middle Name

Nickname

Address

Address Line 2

City

Zip

Primary Hours of Care:

From

Days of the Week in Care:

Meals Typically Served While in Care:

AM Snack

Lunch

PM Snack

Sup

Eve Snack

Family Information

Child Lives With

Mother's information Father's Information

Name

Address

Phone

Employer

Address

Phone

Cell

Medical Information

*I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.

Doctor

Address

Phone

Doctor

Address

Phone

Doctor

Address

Phone

Hospital Preference

Please List allergies special medical or dietary needs, or other areas of concern:

Contacts

Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to removed the child from the facility in case of illness, accident or emergency, if for some reason, the custodial parent or legal guardian cannot be reached

Name

Address

Work#

Home#

Name

Address

Work#

Home#

Name

Address

Work#

Home#

Name

Address

Work#

Home#

By clicking the above button, I consent to be contacted by Baltimore Happy Kids Child Care Center and Webit, Inc. at any email address or telephone number I provide, including, without limitation, communications sent via text message to my cell phone or communications sent using an autodialer or prerecorded message. This acknowledgement constitutes my written consent to receive such communications. I agree and consent to any applicable Terms and Conditions of Use or Privacy Policy available on this website.

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