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? *

Days of Care will begin the week of July 6, 2020.
You may 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 6	Week of July 6Monday	Week of July 6Tuesday	Week of July 6Wednesday	Week of July 6Thursday	Week of July 6Friday
Week of July 13	Week of July 13Monday	Week of July 13Tuesday	Week of July 13Wednesday	Week of July 13Thursday	Week of July 13Friday
Week of July 20	Week of July 20Monday	Week of July 20Tuesday	Week of July 20Wednesday	Week of July 20Thursday	Week of July 20Friday
Week of July 27	Week of July 27Monday	Week of July 27Tuesday	Week of July 27Wednesday	Week of July 27Thursday	Week of July 27Friday
Week of August 3	Week of August 3Monday	Week of August 3Tuesday	Week of August 3Wednesday	Week of August 3Thursday	Week of August 3Friday
Week of August 10	Week of August 10Monday	Week of August 10Tuesday	Week of August 10Wednesday	Week of August 10Thursday	Week of August 10Friday
Week of August 17	Week of August 17Monday	Week of August 17Tuesday	Week of August 17Wednesday	Week of August 17Thursday	Week of August 17Friday
Week of August 24 (First week of School?	Week of August 24 (First week of School?Monday	Week of August 24 (First week of School?Tuesday	Week of August 24 (First week of School?Wednesday	Week of August 24 (First week of School?Thursday	Week of August 24 (First week of School?Friday

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):
Enrolled Pre-3/Pre-4

Half days after school
Preschool Half day after school rate:
Spam Protection. Please answer this simple question.
22, 4, 8, 0 : which of these is the largest?
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