Zion Day Care Schedule Registration Form

Please complete the information below to register for Day Care.

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Parent Name: Parent Name: * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Is your Daycare covered by DHS? *
1.Student Name: 1.Student Name: * First Last
Age of Child *

Age of Child Infant & Toddler (Newborn - 30 months) 2 1/2 years & Older, School age
2.Student Name: 2.Student Name: First Last
Age of Child

Age of Child Infant & Toddler (Newborn - 30 months) 2 1/2 years & Older, School age
3.Student Name: 3.Student Name: First Last
Age of Child

Age of Child Infant & Toddler (Newborn - 30 months) 2 1/2 years & Older, School age
Contact Email: *
Which room will your child attend for care? *

Please fill in by your preference, by week, or two weeks or monthly. Schedules are due on the Wednesday before care is needed:
	Monday	Tuesday	Wednesday	Thursday	Friday
Week of August 31	Week of August 31Monday	Week of August 31Tuesday	Week of August 31Wednesday	Week of August 31Thursday	Week of August 31Friday
Week of September 7	Week of September 7Monday	Week of September 7Tuesday	Week of September 7Wednesday	Week of September 7Thursday	Week of September 7Friday
Week of September 14	Week of September 14Monday	Week of September 14Tuesday	Week of September 14Wednesday	Week of September 14Thursday	Week of September 14Friday
Week of September 21	Week of September 21Monday	Week of September 21Tuesday	Week of September 21Wednesday	Week of September 21Thursday	Week of September 21Friday
Week of September 28	Week of September 28Monday	Week of September 28Tuesday	Week of September 28Wednesday	Week of September 28Thursday	Week of September 28Friday
Week of October 5	Week of October 5Monday	Week of October 5Tuesday	Week of October 5Wednesday	Week of October 5Thursday	Week of October 5Friday
Week of October 12	Week of October 12Monday	Week of October 12Tuesday	Week of October 12Wednesday	Week of October 12Thursday	Week of October 12Friday
Week of October 19	Week of October 19Monday	Week of October 19Tuesday	Week of October 19Wednesday	Week of October 19Thursday	Week of October 19Friday
Week of October 26	Week of October 26Monday	Week of October 26Tuesday	Week of October 26Wednesday	Week of October 26Thursday	Week of October 26Friday

Drop Off Time: *
Pick Up Time *
Drop off/Pick up times if different than above:
Include the week/day/drop off and pick up time.
Zion Day Care Rates

Please select the number of days your child will be attending Zion.
Child Care Rate
Newborn - 30 months
Child Care Rate
2 1/2 yrs & Up, School Age - No School Days
Snow Days/Summer Rate
Ages 5 & Up per Week
Family Rate with 2 Kids (Excludes Infants and Toddlers):
Family Rate with 3 Kids (Excludes Infants and Toddlers):
After School Care

Grades Preschool - 8th Grade
Preschool Half day after school rate:
After School Child Care
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If tomorrow is Saturday what day is today?
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