Enrollment Application | Wee-Folk Child Care Center

Email*

Child's Full Name*

Date of Birth

Center Interested In

Enrollment Date

Age

Sex

Class

Mother's Name

M - Address

M - Home Phone

M - Employer

M - Employer Address

M - Work Phone

M - Cell Phone

M - Email

Father's Name

F - Address

F - Home Phone

F - Employer

F - Employer Address

F - Work Phone

F - Cell Phone

F - Email

Who Does the Child Live With

Emergency Contact #1

E1 - Address

E1 - Home Phone

E1 - Work Phone

Emergency Contact #2

E2 - Address

E2 - Home Phone

E2 - Work Phone

Child's Physician

CP - Phone

CP - Address

Pickup Person #1 - Name

PP1 - Relationship to Child

PP1 - Address

PP1 - Home Phone

PP1 - Work Phone

Pickup Person #2 - Name

PP2 - Relationship to Child

PP2 - Address

PP2 - Home Phone

PP2 - Work Phone

Pickup Person #3 - Name

PP3 - Relationship to Child

PP3 - Address

PP3 - Home Phone

PP3 - Work Phone

Pickup Person #4 - Name

PP4 - Relationship to Child

PP4 - Address

PP4 - Home Phone

PP4 - Work Phone

Is there anyone NOT ALLOWED to pick up your child?

NA - Name

NA - Relationship to Child

NA - Phone

NA - Reason

Enrollment

Enrollment Application for Our Day Care Center

Proudly serving Buffalo, Blasdell, Hamburg, Lackawanna & Orchard Park, NY

Call today for more information about our Daycare Center!