Name, address, phone number, and email address of parents:
Name, sex, and date of birth of children needing child care:
Parents employee, location, days and hours of work:
Days/Hours childcare is needed:
Date you would like to begin childcare:
Type of program desired, full-time, part-time, evening, weekend: Full-time Part-time Evening Weekend
Current child care arrangements:
Past daycare experience:
Reasons for needing new child care:
How did you hear about Giggles and Grins?
I have reviewed and accept Giggles and Grins Operational Policies: Yes No
I consent to Giggles and Grins Learning Center performing a reference check if and when I decide to enroll my child in the program: Yes No
