Register|Login|Search

The Day Care With The Heart!

APPLICATION FOR ADMISSION


Child's Name:

Address:

Phone #:


Date of Birth: Month: Day: Year:

Mothers's Name:

Father's Name:

Child Age Group: Infants (0-18 months) Toddlers (18 months - 3 yrs.) Preschool (3 yrs and up.)

Is Your Child Ready For Day Care?:
My Child Has all his Immunization Shots.
My child has had a physical in the past six months.
If a preschooler, my child is potty-trained.
I am FIA approved.
My child has been to a prior Day Care. List:




721 S. Main Clawson MI. 48017   248-585-0210                            STATE LICENSE # DC630021715