Enrollment Application
Child Name:
Child Home Address:
How did you hear about us?
Your Name:
Your E-mail:
Primary Contact Phone (You):
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Child Date of Birth:
Child Gender:
Secondary Contact Name (Parent/Guardian):
Secondary Contact (Parent/Guardian) Address:
Secondary Contact (Parent/Guardian) Phone:
Secondary Contact(Parent/Guardian) E-mail:
Other People In Primary Residence:

In case you or the other primary parent/guardian is unavailable who can we contact?

Emergency Contact Name:
Emergency Contact Phone:
Relationship:
Secondary Emergency Contact Name:
Secondary Emergency Contact Phone:
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Relationship(2):

Full time daycare is equivalent to 24 full days within a month, part time is considered 12 days within a month.

Are you looking for full time or part time daycare?
Primary Care Physician Name:
Primary Care Physician Phone:
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Dentist:
Dentist Phone:
-
Health Insurance:
Group Number:
People Who Are Authorized To Pick Up My Child From Sonbeam
Name:(1)
Phone:(1)
-
Relationship:(1)
Name:(2)
Phone:(2)
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Relationship:(2)
Name:(3)
Phone:(3)
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Relationship:(3)

Emergency Authorization: In the case of an emergency, the employees of Sonbeam Daycare Center have my permission to take my child by ambulance to medical care at my expense

Electronic Signature (1):

Condition of enrollment

I understand that reasonable effort will be made to accomodate my child in the existing program at Sonbeam. I also understand that it is necessary for any child enrolled to be able to meet the minimum behavior standard of being able to obey the rules of the daycare so that he/she can be kept safe and other children or staff members are not at risk of safety by their actions. I agree to these conditions.


Electronic Signature (2):

By clicking submit, I acknowledge I am a parent/legal guardian of the child being applied for and agree to all stipulations in the above form.

Word Verification:
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