Enrollment Form

* Required information.

Childs Name *
Date of Birth *
Enrollment Date *
Age *
Address *
City *
State *
Zip *
Home Phone Number
Childs Nickname
Gender *
Mother/Guardian Name *
Mothers Drivers License # *
Place of Employeement *
Work Phone
Work Address
Cell Phone
Father/Guardian Name *
Fathers Drivers License Number
Fathers Place of Employment
Fathers Work Address
Fathers Work Phone
Fathers Cell Phone
Are Both Parents in the Home? *
Status *
Which Parent has legal custody?
Names and Ages of other children who attend KidzFit or are living at home
If English is not the primary language, what language is?
Does your child have experience with child care or group play situations? *
Does your child take naps? *
If your child does take naps, for how long?
List any items your child prefers during nap time
When necessary, how does your child best like to be comforted?
What type of discipline does your child respond to?
Does your child have allergies? *
Does your child have any special medical needs? *
Are there any particular behaviors the staff should be aware of?