Scribd
Upload
3 views3 pages

Child Care Registration Fill in Form English

This document is a registration form for child care at Super Children Education Cambodian School. It collects essential information about the child, parent, emergency contacts, authorized pick-ups, and medical details. The form also specifies the required child care hours and days of the week needed.

Uploaded by

Vichheka Thor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
3 views3 pages

Child Care Registration Fill in Form English

This document is a registration form for child care at Super Children Education Cambodian School. It collects essential information about the child, parent, emergency contacts, authorized pick-ups, and medical details. The form also specifies the required child care hours and days of the week needed.

Uploaded by

Vichheka Thor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

Child Care

Registration

Super Children Education Cambodian School

Child's Information

First name Last name M.I.

Street address Street address line 2

City / Province Khan

Male or female?
Female
Male

Hours of child care required (school hours are 7:00 am to 6:00 pm)
Full day
Half-day morning
Half-day afternoon
Other
Days of the week required
Monday
Tuesday
Wednesday
Thursday
Friday

Do you require before or after school care?


Before school
After school

Parent's Information

Parent's/Guardian's name Phone number

Place of work E-mail address

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

First name Last name

Primary phone number Secondary phone number

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

First name Last name

Primary phone number Secondary phone number

Other people authorized to pick up your child from school


First name Last name

First name Last name

Medical information

Doctor Doctor's phone number

Dentist Dentist's phone number

Preferred hospital Insurance/health coverage

Please list any of the following: Current medications, medication allergies, food allergies, or chronic
health concerns.

You might also like