Child Care REQUEST form

This is where you will come each month to complete your request for childcare.
2 weeks notice is required for any change to be approved otherwise normal daily fees will apply.

Child Care Request Form

* Indicates required field

MONTH *

Parent/Guardian Name *

First

Last

Email *

Name of Child(ren) *

Who is your child care provider? (first and last name) *

Dates of care Requested, Enter dates as: numbers divided by commas (e.g. 1, 2, 3, etc) *

Drop off and pick up times requested. *

Dates to be used as planned holidays, (if your child will not be in attendance as outlined in your agreement please include dates to be used as holidays here). *

It is the parent/guardian's responsibility to ensure all information provided is correct. Any change must be submitted with at least two weeks notice or normal daily fees will apply. It is the parent/guardian's responsibility to know and be aware of all policies regarding attendance, schedules and payment *

I accept the terms of service

Submit