Infants & Toddlers Registration form

Infants & Toddlers Registration form
Child's Name*
First Name M.I Last Name
Birth Date*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Mother/Guardian Name*
Work Phone #
Home Phone #*
Father/Guardian Name*
Work Phone #
Home Phone #*
Emergency Contact Person*
Relationship*
Emergency Phone Number*
Formula
Pampers
Baby Wipes
Cereal
Parent/Guardian Signature*
Date

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