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 July 12	Week of July 12Monday	Week of July 12Tuesday	Week of July 12Wednesday	Week of July 12Thursday	Week of July 12Friday
Week of July 19	Week of July 19Monday	Week of July 19Tuesday	Week of July 19Wednesday	Week of July 19Thursday	Week of July 19Friday
Week of July 29	Week of July 29Monday	Week of July 29Tuesday	Week of July 29Wednesday	Week of July 29Thursday	Week of July 29Friday
Week of August 2	Week of August 2Monday	Week of August 2Tuesday	Week of August 2Wednesday	Week of August 2Thursday	Week of August 2Friday
Week of August 9	Week of August 9Monday	Week of August 9Tuesday	Week of August 9Wednesday	Week of August 9Thursday	Week of August 9Friday
Week of August 16	Week of August 16Monday	Week of August 16Tuesday	Week of August 16Wednesday	Week of August 16Thursday	Week of August 16Friday
Week of August 23	Week of August 23Monday	Week of August 23Tuesday	Week of August 23Wednesday	Week of August 23Thursday	Week of August 23Friday
Week of August 30	Week of August 30Monday	Week of August 30Tuesday	Week of August 30Wednesday	Week of August 30Thursday	Week of August 30Friday
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

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
Summer Program Registration
$25 per day / per child
1 Child
2 Children
3 Children
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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

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

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Total

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Summer Program Registration
$25 per day / per child

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