Child Information Record

All families are required to complete the Child Information Record Form prior to their child’s first day of attendance. This form must be filled out completely with no blanks to meet state licensing requirements.

Please review carefully and include the following:

• Date of Admission
  Enter your child’s first day of attendance

• Employer Information
  List employer name and phone number, or write “none”

• Allergies
  Check Yes or No
  If your child has allergies, please also email us with details

Emergency Contacts

• First list parents/guardians

• Then include additional emergency contacts and/or individuals authorized to pick up your child

• Be sure to include name, relationship, and phone number

Example: Sue Fabiano (Grandma) – 616-566-1234

Additional Requirements

• Initials
  Add your initials in the section granting permission for medical treatment

• Signature
  You may print your name in the signature section, then be sure to date the form

Submitting Your Form

• Once completed, please upload the form to your Enrollsy account

If you have any questions, feel free to contact us—we’re happy to help!