LITTLE ANGELS 2023-2024 ENROLLMENT FORM

PARENTS, PLEASE NOTE:

PRESCHOOL CLASSES ARE LIMITED TO A MAXIMUM OF 12 CHILDREN.

PARENT INFORMATION
Mother's name*
First Last
Mother's address*
Same as child

Street Address Address Line 2 City State ZIP Code
Mother's home phone (please include area code)*
Mother's cell phone (please include area code)*
Mother's work phone (please include area code)*
Mother's email*
Mother's employer*
Mother's work address (if applicable)
Street Address Address Line 2 City State ZIP Code
Mother's work hours (specific times required)*
Father's name*
First Last
Father's address*
Same as Child

Street Address Address Line 2 City State ZIP Code
Father's home phone (please include area code)*
Father's cell phone (please include area code)*
Father's work phone (please include area code)*
Father's email*
Father's employer*
Father's Work Address (if applicable)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Father's work hours (specific times required)*
Parent's marital status*
Child lives with*
- Both parents
- Father
- Mother
- Step Father
- Step Mother
- Guardian(s)

EMERGENCY CONTACTS AND PERSONS AUTHORIZED TO TAKE CHILD FROM FACILITY
Parents: Do not list yourselves. This area is for additional contacts in case you cannot be reached.
Contact person #1 (other than parent)*
First Last
Relationship to child*
Address*
Street Address Address Line 2 City State ZIP Code
Phone (please include area code)*
Contact person #2 (other than parent)*
First Last
Relationship to child*
Address*
Street Address Address Line 2 City State ZIP Code
Phone (please include area code)*
Additional persons authorized to take child from facility

CHILD INFORMATION