School Age Child Care Supplemental Enrollment Form School Age Child Care Supplemental Enrollment FormCompletion of this agreement is required for enrollment. This form will enable us to better understand your child and meet his/her needs. Much of the information requested is necessary to comply with state child care licensing regulations.Enrollment InformationChild’s InformationChild’s first nameChild’s middle nameChild’s last nameChild’s nicknameAgeSexChild’s primary languageParent/guardian/sponsor primary languageAddress Street Address City State / Province / Region ZIP / Postal Code Does your child attend school?YesNoSchool nameGradeSchool phoneSchool addressDrop off timePick up timeChild will be attending:Morning CareAfternoon Care**All children must be escorted into the center and out of the center upon arrival and departing by an authorized adult. After School Activities InformationComplete the information below to provide us with details about after school activities your child is participating in. Please complete a separate Transportation and School Activity form for each activity.Transportation and After School ActivityMy child is transported to school via:My child is transported from school via:Bus #:Parents are responsible for informing child care center in writing if your child(ren) will be participating in an after school activity:Child participates in the following after school activities (list all):Type of Activity:Day of the week child is attending activities (circle all that apply): M Tu W Th F Time period of activity:Day:Start Time:End Time: Time period of activity:Day:Start Time:End Time: Time period of activity:Day:Start Time:End Time: Time period of activity:Day:Start Time:End Time: Time period of activity:Day:Start Time:End Time: Name of authorized person to pick up / drop off your child for the extracurricular activity: Your child’s safety is our number one priority. A Child’s World will not release children from the program without the above information in writing.
