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Enroll today
Registration Form
Thank you
{{_name}}
. We will be contacting you via
{{parents_email}} or {{parents_cell_phone}},
regarding
{{first_name}}'s enrollment into Chappelle Daycare.
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Welcome to Chappelle Daycare. This is our online registration form
Continue
Pleased to meet you
{{_name}}
.
Kindly fill in your child details
Program Information at start date
Full time
Part time
*Gender
Male
Female
Preferred start date
Would you like to be notified if an earlier start date is available?
Yes
No
Continue
Please, provide parents/guardian information
regarding
{{first_name}}'s
enrolment.
*Relationship to child
Mother
Father
Legal Guardian
Brother
Sister
Stepfather
Stepmother
*Authorized to pick-up child
Yes
No
Home Address
Business Information
Signature (Parent/Guardian 1) - I agree that my typed name will be as valid as a handwritten signature to the extent allowed by local law *
Signature
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Please, provide emergency contact information
regarding
{{first_name}}'s
enrolment.
*Relationship to child
Grandmother
Grandfather
Aunt
Uncle
Cousin
Family friend
Priest
Teacher
Instructor
Nanny
*Authorized to pick-up child
Yes
No
Home Address
Continue
Alternative emergency contact information
regarding
{{first_name}}'s
enrolment.
*Would you like to add another Emergency Contact and Authorized Pick-up?
Yes
No
*Relationship to child
Grandmother
Grandfather
Aunt
Uncle
Cousin
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Priest
Teacher
Instructor
Nanny
*Authorized to pick-up child
Yes
No
Home Address
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Does
{{first_name}}'s
has any allergy or food restrictions? Please tell us
*My child has Allergies?
Yes
No
*Allergies sensitivity
Strong (anaphylactic) - Requires An Epi-pen
Mild (medication on site)
*Allergic to
Peanuts
Tree nuts (Cashew, Hazelnut, Pecan, Walnut, Pistachio)
Insect stings
Egg
Shellfish
Dairy
Sesame
Medication
Others
*Other Allergies
*My child has Food Restriction?
Yes
No
*Food Restriction
Beef
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Finally
{{_name}}
, we would like to know about
{{first_name}}'s
health
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780-250-5222
Home
About
About Us
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All Programs
Infants
Toddlers
Preschool
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For Our Parents
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Enroll today
Interactive Form
Thank you
{{_name}}
. We will be contacting you via
{{contact_method}},
regarding your
{{product_selection}}.
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Hi
Welcome to Chappelle Daycare. This is our online registration form
Continue
Pleased to meet you
{{_name}}
.
Kindly fill in your child details
Radio Buttons
Male
Female
Continue
Please give a short description of the requirements
regarding your
{{product_selection}}
.
Continue
Thank you
{{_name}}
.
How would you like to be contacted?
Email
Phone
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Submit
+1 541-754-3010
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