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 December 21	Week of December 21Monday	Week of December 21Tuesday	Week of December 21Wednesday	Week of December 21Thursday	Week of December 21Friday
Week of December 28	Week of December 28Monday	Week of December 28Tuesday	Week of December 28Wednesday	Week of December 28Thursday	Week of December 28Friday
Week of January 4	Week of January 4Monday	Week of January 4Tuesday	Week of January 4Wednesday	Week of January 4Thursday	Week of January 4Friday
Week of January 11	Week of January 11Monday	Week of January 11Tuesday	Week of January 11Wednesday	Week of January 11Thursday	Week of January 11Friday
Week of January 18	Week of January 18Monday	Week of January 18Tuesday	Week of January 18Wednesday	Week of January 18Thursday	Week of January 18Friday
Week of January 25	Week of January 25Monday	Week of January 25Tuesday	Week of January 25Wednesday	Week of January 25Thursday	Week of January 25Friday
Week of February 1	Week of February 1Monday	Week of February 1Tuesday	Week of February 1Wednesday	Week of February 1Thursday	Week of February 1Friday
Week of February 8	Week of February 8Monday	Week of February 8Tuesday	Week of February 8Wednesday	Week of February 8Thursday	Week of February 8Friday
Week of February 15	Week of February 15Monday	Week of February 15Tuesday	Week of February 15Wednesday	Week of February 15Thursday	Week of February 15Friday
Week of February 22	Week of February 22Monday	Week of February 22Tuesday	Week of February 22Wednesday	Week of February 22Thursday	Week of February 22Friday

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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