Child Development Center

Please Complete and Submit This Form for Child Enrollment in the CDC!

CHILD ADMISSION RECORD

GENERAL INFORMATION:

FATHER/GUARDIAN Information:

MOTHER/GUARDIAN Information:

EMERGENCY/MEDICAL INFORMATION:

FAMILY/HOME INFORMATION:

CHILD CARE INFORMATION:

Consent is for normal activities unless indicated below – The following activities may occur during the course of the day at Higher Ground Child Development Center. 

Please initial those activities your child does not have permission to participate in:

The following persons have my permission to pick up my child from the Center:

No child may be released from Higher Ground Child Development Center to any person other than his/her parents or other person designated in writing by such parent to receive the child. Those people designated to pick-up the child (including parents) need to present photo identification each day until easily recognized by the provider

The following persons have my permission to pick-up my child from the Center:

I/We certify that all of the information given on this form is correct and accurate according to our best knowledge. I/We promise that I/We will notify the provider, if any or all of the information changes.

0 + 8 = ?