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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.
1
1
  • 1
    Step 1
    Parent's name
  • 2
    Step 2
    Child Info
  • 3
    Step 3
    Parents/Guardian information
  • 4
    Step 4
    Emergency Contact
  • 5
    Step 5
    Add Another Emergency Contact
  • 6
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    Allergy and Food Restrictions
  • 7
    Step 7
    Health History
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Hi

Welcome to Chappelle Daycare. This is our online registration form
Pleased to meet you {{_name}}.

Kindly fill in your child details
Please, provide parents/guardian information
regarding {{first_name}}'s enrolment.

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 *

Please, provide emergency contact information
regarding {{first_name}}'s enrolment.

Home Address

Alternative emergency contact information
regarding {{first_name}}'s enrolment.

Home Address

Does {{first_name}}'s has any allergy or food restrictions? Please tell us
Finally {{_name}}, we would like to know about {{first_name}}'s health

Doctor's Address

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Menu
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Book a Visit
  • 780-250-5222
  • Home
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Menu
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Interactive Form

Thank you {{_name}}. We will be contacting you via {{contact_method}}, regarding your {{product_selection}}.
1
1
  • 1
    Step 1
    Parent's name
  • 2
    Step 2
    Child Info
  • 3
    Step 3
  • 4
    Step 4
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Hi

Welcome to Chappelle Daycare. This is our online registration form
Pleased to meet you {{_name}}.

Kindly fill in your child details
Please give a short description of the requirements
regarding your
{{product_selection}}.
Thank you {{_name}}.
How would you like to be contacted?
  • +1 541-754-3010​
  • Home
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Phone: 780-250-5222
kids@chappelledaycare.ca

Opening Hours: Mon-Fri, 6am-6pm

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.
1
1
  • 1
    Step 1
    Parent's name
  • 2
    Step 2
    Child Info
  • 3
    Step 3
    Parents/Guardian information
  • 4
    Step 4
    Emergency Contact
  • 5
    Step 5
    Add Another Emergency Contact
  • 6
    Step 6
    Allergy and Food Restrictions
  • 7
    Step 7
    Health History
0%
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true
message
https://chappelledaycare.ca/wp-admin/admin-ajax.php
https://chappelledaycare.ca/test-2
yes
1
fadeIn
fadeOut
Hi

Welcome to Chappelle Daycare. This is our online registration form
Pleased to meet you {{_name}}.

Kindly fill in your child details
Please, provide parents/guardian information
regarding {{first_name}}'s enrolment.

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 *

Please, provide emergency contact information
regarding {{first_name}}'s enrolment.

Home Address

Alternative emergency contact information
regarding {{first_name}}'s enrolment.

Home Address

Does {{first_name}}'s has any allergy or food restrictions? Please tell us
Finally {{_name}}, we would like to know about {{first_name}}'s health

Doctor's Address

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