Days Of The Week *

Monday

Tuedsay

Wednesday

Thursday

Friday

Saturday

Child Name *

First Name

Last Name

Date Of Birth *

MM

DD

YYYY

Second Child - Name

Optional

First Name

Last Name

Second Child - Date of Birth

Optional

MM

DD

YYYY

Parent / Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Start Date *

MM

DD

YYYY

Neighborhood Walks and/or Park Visits Consent *

We occasionally take children out for neighborhood walks, stroller rides, and/or visits to local parks. These outings are a regular part of our childcare program. Separate consent will be requested for field trips to locations such as pumpkin patches, museums, farms, or similar destinations.

Yes, I give permission for my child to participate in neighborhood walks and/or park visits.

No, I do not give permission for my child to participate in neighborhood walks and/or park visits.