Online registration

Start a childcare registration packet.

Families can submit registration details online. The selected school receives the packet, reviews it, and follows up with next steps.

School review

Authorized school staff review medical, custody, pickup, and emergency details.

Direct follow-up

The selected school receives the packet and contacts the family about next steps.

Step 1

School and Program

Select the school receiving this registration packet.

Step 2

Parent or Guardian

Contact, employment, billing, and identification details from the registration packet.

Primary guardian name

Primary email

Primary cell phone

Primary cell carrier

Primary home phone

Primary work phone

Primary address

Primary relationship to child

Primary place of employment

Primary driver's license

Primary social security number if required

Secondary guardian name

Secondary email

Secondary cell phone

Secondary cell carrier

Secondary home phone

Secondary work phone

Secondary address

Secondary relationship

Secondary place of employment

Secondary driver's license

Secondary social security number if required

Billing contact name

Billing email

Billing phone

Child Information

Identity, household, previous care, and daily routine details.

Child full name

Preferred name

Date of birth

Gender

Child address

Primary language at home

Child lives with

Previously cared for

Siblings, names, and ages

Child's day is usually

In new situations, my child tends to

What Makes My Child Special

Eating, sleeping, development, toileting, goals, and family participation notes.

Medical, Allergy, and Care Plan

Medical, allergy, medication, insurance, and emergency treatment details are protected for director review.

Special needs notes

Other medical conditions

Allergies

Allergy action plan

Allergic reaction signs and symptoms

Preventative measures

Emergency care in event of exposure

Emergency medication administration instructions

Emergency care plan contacts

Medications

Medication authorization form may be needed.

Dietary restrictions

Additional medical or care notes

Child's physician

Physician phone

Dentist

Dentist phone

Preferred hospital

Insurance company

Policy or group number

Insurance notes

Immunization status

Immunization expiration date

Physical expiration date

4C / ELC expiration date

Restricted pickup people

Custody or restricted pickup notes

Emergency Contacts and Permissions

The director will review these before they are added to the family account.

Nutrition, Food Activities, and Uniforms

Policies, food activity choices, and uniform order details from the Kid City packet.

I acknowledge the Child Care Nutrition and Physical Activity Policies.I authorize food program participation and meal service records.

Permission for food-related activities

Food allergy or dietary restriction statement

Foods child may not eat or handle

Black uniform quantity

Black uniform size

Yellow uniform quantity

Yellow uniform size

Uniform payment choice

Uniform payment amount

Uniform comments

Food Program Free/Reduced Meal Application

Optional household and income information for the child care food program application.

Complete a food program free/reduced meal application for this child.

FAP/SNAP case number

TANF case number

Attended this center this year?

Head Start / Pre-K / After School?

Child income

Household members

Adult household income

Last four digits of adult household member SSN

Adult household member has no SSN.

Optional ethnicity

Optional race

Meal application signature name

Meal application signature date

Financial Agreement and Handbook Receipt

Initial each financial term and acknowledge the handbook, emergency procedures, and policy receipts.