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 - 3 yrs) Preschool (3 - 4 yrs) School Age (5 yrs and older)
2.Student Name: 2.Student Name: First Last
Age of Child

Age of Child Infant & Toddler (Newborn - 3 yrs) Preschool (3 - 4 yrs) School Age (5 yrs and older)
3.Student Name: 3.Student Name: First Last
Age of Child

Age of Child Infant & Toddler (Newborn - 3yrs) Preschool (3 - 4 yrs) School Age (5 yrs and older)
Contact Email: *
Which room will your child attend for care? *
Which room will your child attend care for?

Which room will your child attend care for? Infant Room/Red Room (6wk - 14 months) - Miss Sarah Toddler Room/Green Room (14 months - 3 Years) - Miss Claire Preschool Room/Orange Room (3 yrs - 4 yrs) - Miss Jasmine Summer Program (5 yrs and older) Miss Justice

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 September 5	Week of September 5Monday	Week of September 5Tuesday	Week of September 5Wednesday	Week of September 5Thursday	Week of September 5Friday
Week of September 12	Week of September 12Monday	Week of September 12Tuesday	Week of September 12Wednesday	Week of September 12Thursday	Week of September 12Friday
Week of September 19	Week of September 19Monday	Week of September 19Tuesday	Week of September 19Wednesday	Week of September 19Thursday	Week of September 19Friday
Week of September 26	Week of September 26Monday	Week of September 26Tuesday	Week of September 26Wednesday	Week of September 26Thursday	Week of September 26Friday
Week of October 3	Week of October 3Monday	Week of October 3Tuesday	Week of October 3Wednesday	Week of October 3Thursday	Week of October 3Friday
Week of October 10	Week of October 10Monday	Week of October 10Tuesday	Week of October 10Wednesday	Week of October 10Thursday	Week of October 10Friday
Week of October 17	Week of October 17Monday	Week of October 17Tuesday	Week of October 17Wednesday	Week of October 17Thursday	Week of October 17Friday
Week of October 24	Week of October 24Monday	Week of October 24Tuesday	Week of October 24Wednesday	Week of October 24Thursday	Week of October 24Friday
Week of October 31	Week of October 31Monday	Week of October 31Tuesday	Week of October 31Wednesday	Week of October 31Thursday	Week of October 31Friday
Week of November 7	Week of November 7Monday	Week of November 7Tuesday	Week of November 7Wednesday	Week of November 7Thursday	Week of November 7Friday
Week of November 14	Week of November 14Monday	Week of November 14Tuesday	Week of November 14Wednesday	Week of November 14Thursday	Week of November 14Friday
Week of November 21	Week of November 21Monday	Week of November 21Tuesday	Week of November 21Wednesday	Week of November 21Thursday	Week of November 21Friday
Week of November 28	Week of November 28Monday	Week of November 28Tuesday	Week of November 28Wednesday	Week of November 28Thursday	Week of November 28Friday

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 - 3 Years
Child Care Rate
3 Years and Older - 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.
What is the sum of 5 and 3 ?
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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`