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 March 7	Week of March 7Monday	Week of March 7Tuesday	Week of March 7Wednesday	Week of March 7Thursday	Week of March 7Friday
Week of March 14	Week of March 14Monday	Week of March 14Tuesday	Week of March 14Wednesday	Week of March 14Thursday	Week of March 14Friday
Week of March 21	Week of March 21Monday	Week of March 21Tuesday	Week of March 21Wednesday	Week of March 21Thursday	Week of March 21Friday
Week of March 28	Week of March 28Monday	Week of March 28Tuesday	Week of March 28Wednesday	Week of March 28Thursday	Week of March 28Friday
Week of April 4	Week of April 4Monday	Week of April 4Tuesday	Week of April 4Wednesday	Week of April 4Thursday	Week of April 4Friday
Week of April 11	Week of April 11Monday	Week of April 11Tuesday	Week of April 11Wednesday	Week of April 11Thursday	Week of April 11Friday
Week of April 18	Week of April 18Monday	Week of April 18Tuesday	Week of April 18Wednesday	Week of April 18Thursday	Week of April 18Friday
Week of April 25	Week of April 25Monday	Week of April 25Tuesday	Week of April 25Wednesday	Week of April 25Thursday	Week of April 25Friday
Week of May 2	Week of May 2Monday	Week of May 2Tuesday	Week of May 2Wednesday	Week of May 2Thursday	Week of May 2Friday
Week of May 9	Week of May 9Monday	Week of May 9Tuesday	Week of May 9Wednesday	Week of May 9Thursday	Week of May 9Friday
Week of May 16	Week of May 16Monday	Week of May 16Tuesday	Week of May 16Wednesday	Week of May 16Thursday	Week of May 16Friday
Week of May 23	Week of May 23Monday	Week of May 23Tuesday	Week of May 23Wednesday	Week of May 23Thursday	Week of May 23Friday
Week of May 30	Week of May 30Monday	Week of May 30Tuesday	Week of May 30Wednesday	Week of May 30Thursday	Week of May 30Friday
Week of June 6	Week of June 6Monday	Week of June 6Tuesday	Week of June 6Wednesday	Week of June 6Thursday	Week of June 6Friday

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 - Non 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
Pre 3 Half day after school:
Mondays, Wednesdays & Fridays
Pre 4: Half day after school:
Mondays, Tuesdays, Wednesdays & Thursdays
After School Child Care
Summer Program Registration
$25 per day / per child
1 Child
2 Children
3 Children
Spam Protection. Please answer this simple question.
In the number 73627, what is the 3rd digit?
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Zion Day Care Schedule Registration Form

Zion Day Care Schedule Registration Form

$`0`

Total

Zion Day Care Rates

After School Care

Summer Program Registration
$25 per day / per child

$`0`

Total

Zion Day Care Schedule Registration Form

Zion Day Care Schedule Registration Form

$0

Total

Zion Day Care Rates

After School Care

Summer Program Registration $25 per day / per child

$0

Total

$`0`

Summer Program Registration
$25 per day / per child

$`0`