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 September 6	Week of September 6Monday	Week of September 6Tuesday	Week of September 6Wednesday	Week of September 6Thursday	Week of September 6Friday
Week of September 13	Week of September 13Monday	Week of September 13Tuesday	Week of September 13Wednesday	Week of September 13Thursday	Week of September 13Friday
Week of September 20	Week of September 20Monday	Week of September 20Tuesday	Week of September 20Wednesday	Week of September 20Thursday	Week of September 20Friday
Week of September 27	Week of September 27Monday	Week of September 27Tuesday	Week of September 27Wednesday	Week of September 27Thursday	Week of September 27Friday
Week of October 4	Week of October 4Monday	Week of October 4Tuesday	Week of October 4Wednesday	Week of October 4Thursday	Week of October 4Friday
Week of October 11	Week of October 11Monday	Week of October 11Tuesday	Week of October 11Wednesday	Week of October 11Thursday	Week of October 11Friday
Week of October 18	Week of October 18Monday	Week of October 18Tuesday	Week of October 18Wednesday	Week of October 18Thursday	Week of October 18Friday
Week of October 25	Week of October 25Monday	Week of October 25Tuesday	Week of October 25Wednesday	Week of October 25Thursday	Week of October 25Friday
Week of November 1	Week of November 1Monday	Week of November 1Tuesday	Week of November 1Wednesday	Week of November 1Thursday	Week of November 1Friday
Week of November 8	Week of November 8Monday	Week of November 8Tuesday	Week of November 8Wednesday	Week of November 8Thursday	Week of November 8Friday
Week of November 15	Week of November 15Monday	Week of November 15Tuesday	Week of November 15Wednesday	Week of November 15Thursday	Week of November 15Friday
Week of November 22	Week of November 22Monday	Week of November 22Tuesday	Week of November 22Wednesday	Week of November 22Thursday	Week of November 22Friday
Week of November 29	Week of November 29Monday	Week of November 29Tuesday	Week of November 29Wednesday	Week of November 29Thursday	Week of November 29Friday

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
Pre 3 Half day after school:
Mondays, Wednesdays & Fridays
Pre 4: Half day after school:
Mondays, Wednesdays & Fridays
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.
If tomorrow is Monday what day is today?
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Zion Day Care Schedule Registration Form

Zion Day Care Schedule Registration Form

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Zion Day Care Rates

After School Care

Summer Program Registration
$25 per day / per child

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Zion Day Care Schedule Registration Form

Zion Day Care Schedule Registration Form

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Total

Zion Day Care Rates

After School Care

Summer Program Registration $25 per day / per child

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Total

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Summer Program Registration
$25 per day / per child

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