Contact details of the parent or caregiver(Required)

First Name Last Name

Phone(Required)

Email(Required)

Number of children(Required)

Please enter a number from 1 to 4.

CHILD INFORMATION(Required)

For 2 or more children, please write their names separated by commas.

First Name Last Name

Date of birth(Required)

Date of birth

For 2 or more children, please write their dates of birth separated by commas.

GENDER(Required)

Male

Female

Would rather not say

Gender

For 2 or more children, please write their gender (boy/girl) separated by commas.

Child's native language(Required)

Other languages the child can understand or communicate in

DOES YOUR CHILD SPEAKS/ UNDERSTAND ENGLISH?(Required)

Yes, fluently (speaks and understands well)

Intermediate (speaks a little but understands well)

Basic (does not speak but understands a little)

No, not at all

DOES YOUR CHILD HAVE ANY ALLERGIES/ SPECIAL DIET(Required)

NO

YES

DOES YOUR CHILD HAVE ANY MEDICAL TREATMENT?(Required)

NO

YES

If your child has any allergies, special dietary requirements, or medical treatments, please provide us with the necessary details.

Does your child need to take a nap during a daycare time? If yes, tell us ay specifics (time, duration, pacifier etc.)(Required)

Additional information about your child that you would like to share with us:

SELECT DAY(S)(Required)

Wednesday, September 17th

Thursday, September 18th

Friday, September 19th

Saturday, September 20th

Estimated time of arrival and pickup for the kids(Required)

Daily rate per one child

Price:

EADV x BABY PRESTIGE Childcare service

Child Intake Form