Please complete one form for EACH CHILD you would like to enroll in Germantown Christians Day Care.

Parent

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Details of Services Needed

Please complete One form for EACH CHILD

Child's Name

First Name

Last Name

Child's Birth Date

YYYY

Age Group

Days Needed

Monday

Tuesday

Wednesday

Thursday

Friday

Time of Day

Mornings

Afternoons

All Day