Application for Child Care

Thank you for your interest in Hawfields Child Care! Please complete the following Application for Child Care to add your child to our waiting list. Please click the link below for our Application and Waitlist Procedures.

Application and Waitlist Procedures

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Please fill out all the fields below to be placed on file prior to enrollment.

Child's First Name

Child's Last Name

Birth Date

Home Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Information About the Family

Father/Guardian's First Name

Last Name

Phone

Where Employed

Business Phone

Mother/Guardian's First Name

Last Name

Phone

Where Employed

Business Phone

Information About the Child

Does the child have any known allergies?

Please explain the child's allergies.

Is your child Potty Trained

Has your child been enrolled in a child care program previously?

If Yes, where was your child enrolled? How long?

Do you have any concerns of behavioral challenges or developmental delays?

Checkbox Description

Please explain any behavioral challenges or developmental delays below.

Please provide any additional information concerning your child that will be helpful in his/her experience in a group setting (such as play, eating, and sleeping habits, special fears, special likes or dislikes).

Emergency Care Information

Child's Doctor

Office Phone

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Child's Dentist

Office Phone

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Hospital Preference

Phone

Emergency Contacts

If neither father nor mother (or guardian) can be contacted, call:

First Name

Last Name

Home Phone

Office Phone

Relationship

First Name

Last Name

Home Phone

Office Phone

Relationship

If you can not come for your child, please give the names of persons to whom the child can be released

Emergency Release

I agree that the operator may authorize the physician of his/her choice to provide emergency care in the event that neither I nor the family physician can be contacted immediately.

I agree

Hawfields Child Development Center agrees to provide transportation to an appropriate medical resource in the event of emergency. In an emergency situation, other children in the facility will be supervised by a responsible adult. I will not administer any drug or any medication without specific instructions from the physician or the child's parent, guardian, or full-time custodian. Provisions will be made for adequate and appropriate rest and outdoor play.

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Application for Child Care

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