Little Lambs Day Care, Inc.
Application for Care

Date _________________

Child's Name _______________________________________Birthdate______________________

Parent's Names____________________________________________________________________
             
Address(s)________________________________________________________________________
       
Home Phone(s)   __________________________________________________________________

Cell Phone(s)  ____________________________________________________________________

Email ___________________________________confirm email____________________________
Yes, I'd like to receive the monthly newsletter via email (check here) ____

Days of the week you're contracting for ___________________

Start Date ____________ Special Concerns   __________________________________________

Fun & Fitness Friday   _______    Piano Lessons  _____________

OFFICE USE ONLY

Registration paid   __________   Escrow paid   ______________ Tee Shirt ________________