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 February 22	Week of February 22Monday	Week of February 22Tuesday	Week of February 22Wednesday	Week of February 22Thursday	Week of February 22Friday
Week of March 1	Week of March 1Monday	Week of March 1Tuesday	Week of March 1Wednesday	Week of March 1Thursday	Week of March 1Friday
Week of March 8	Week of March 8Monday	Week of March 8Tuesday	Week of March 8Wednesday	Week of March 8Thursday	Week of March 8Friday
Week of March 15	Week of March 15Monday	Week of March 15Tuesday	Week of March 15Wednesday	Week of March 15Thursday	Week of March 15Friday
Week of March 22	Week of March 22Monday	Week of March 22Tuesday	Week of March 22Wednesday	Week of March 22Thursday	Week of March 22Friday
Week of March 29	Week of March 29Monday	Week of March 29Tuesday	Week of March 29Wednesday	Week of March 29Thursday	Week of March 29Friday
Week of April 5	Week of April 5Monday	Week of April 5Tuesday	Week of April 5Wednesday	Week of April 5Thursday	Week of April 5Friday
Week of April 12	Week of April 12Monday	Week of April 12Tuesday	Week of April 12Wednesday	Week of April 12Thursday	Week of April 12Friday
Week of April 19	Week of April 19Monday	Week of April 19Tuesday	Week of April 19Wednesday	Week of April 19Thursday	Week of April 19Friday
Week of April 26	Week of April 26Monday	Week of April 26Tuesday	Week of April 26Wednesday	Week of April 26Thursday	Week of April 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
Spam Protection. Please answer this simple question.
5, 6, 7, 8 : the 2nd number is?
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