Child care registration form

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Child Care Registration

Bridgeland Montessori House


    Child's Information

    Name
    M.I.
    Address *
    Street Address
    City *
    State / Province *
    Postal / Zip Code*
    Male or female?
    Hours of child care required (school hours are 7:00 am to 6:00 pm)
    Days of the week required *

    Parent #1

    Name *
    Phone Number *
    Place of work
    Email address *
    Address *

    Parent #2

    Name *
    Phone Number *
    Place of work
    Email address *
    Address *

    Emergency Contact 1 in the event of an emergency, please contact:

    Name *
    Primary Phone Number *
    Secondary Phone Number

    Emergency Contact 2 in the event of an emergency, please contact:

    Name *
    Primary Phone Number *
    Secondary Phone Number

    Other people authorized to pick up your child from school (OPTIONAL)

    Name
    Name

    Medical information

    Doctor's Name *
    Doctor's Phone Number *
    Preferred hospital
    Insurance/health coverage (optional)
    Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns.