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CHILDREN’S PRE-ENROLLMENT FORM
CHILD'S NAME
DATE OF BIRTH
CHILD'S SEX
Select
MALE
FEMALE
HOME ADDRESS (STREET)
CITY
STATE
ZIP CODE
PHONE NUMBER
FATHER'S FULL NAME
FATHER'S PLACE OF EMPLOYMENT
EMPLOYER'S ADDRESS (STREET)
CITY
STATE
ZIP CODE
WORK PHONE
MOTHER'S FULL NAME
MOTHER'S PLACE OF EMPLOYMENT
EMPLOYER'S ADDRESS
CITY
STATE
ZIP CODE
WORK PHONE
Child’s Living Arrangements
BOTH PARENTS
MOTHER
FATHER
OTHER
Child’s Legal Guardian(s)
BOTH PARENTS
MOTHER
FATHER
OTHER
CHILD'S DOCTOR OR CLINIC NAME
DOCTOR/CLINIC PHONE #
MY CHILD HAS THE FOLLOWING SPECIAL NEEDS
MY CHILD IS CURRENTLY ON MEDICATION(S) PRESCRIBED FOR LONG TERM CONTINUOUS USE AND/OR HAS THE FOLLOWING PREEXISTING ILLNESS, ALERGIES, OR HEALTH CONCERNS.
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PRE-ENROLL
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About the Kids World Daycare Center!
Excellent child care in a safe, eco-friendly, trusted and nurturing environment in the state-of-the-art facilities
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1560 Old York Rd, Abington, PA 19001
215 559 7799
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