RM_Stats

Welcome to the Wright Daycare!

Fill out the form below to confirm your spot now!

Child Information

First Name^*

Last Name^*

Address^*

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Country ^*

ZIP ^*

Gender

Male
Female
Other

What Is Your Child's Age & DOB?

Do You Have Additional Children? Please Specify Name, Age, DOB

Date Childcare Starts

Parent/ Guardian Information

First Name^*

Last Name^*

Phone^*

Email^*

Address^*

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Country ^*

ZIP ^*

Occupation^*

Emergency Contact

First Name^*

Last Name^*

Phone^*

Email^*

Health Declarations

Please fill-up this form as required by the Government that will require you to declare any illness and provide information that will aid in contract tracing, should the need arise. Be sure that the information you give is accurate and complete. All the information submitted shall be encrypted, and strictly used only in compliance to law, guidelines, and ordinances, in relation to business operation in light of COVID-19 response.

Any medical concerns? ^*

Does your child take any medications?

Please specify

Does your child have any kind of allergies?

Please specify

Does your child participate (or will participate) in any form of therapy? (Speech, Language, Occupational, Physical, Behavioral...etc)

Please specify

Please specify^*

Declaration and Consent

By signing this form, I declare that the information I have given is true, correct, and complete. I understand that failure to answer any question or giving a false answer can be penalized in accordance with the law.

Signature

Date^*

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Registration (Waiting List)

Welcome to the Wright Daycare!

Fill out the form below to confirm your spot now!