Child Care Enrollment
Thank you for your interest in St. John's Childcare! Summer childcare at St. John's begins on Monday, June 3 and ends on Friday, August 16.
First Child's Name*
First Child's Date of Birth*
First Child's Gender*
Second Child's Name
Second Child's Date of Birth
Second Child's Gender
Third Child's Name
Third Child's Date of Birth
Third Child's Gender
Fourth Child's Name
Fourth Child's Date of Birth
Fourth Child's Gender
Mother's Name*
Father's Name*
Parent's E-Mail Address*
Phone Number*
Address*
Is your child currently enrolled in St. John's childcare?*
 Yes
 No
Has your child ever been enrolled in St. John's childcare?*
 Yes
 No
Does your child have any health problems or allergies? If yes, please specify*
Please list the names of people authorized to pick up your child other than parents or legal guardians.*
Please specify the start and end time for childcare on Mondays.*
Please specify the start and end time for childcare on Tuesdays.*
Please specify the start and end time for childcare on Wednesdays.*
Please specify the start and end time for childcare on Thursdays.*
Please specify the start and end time for childcare on Fridays.*
By submitting this form I understand that:

--Registration forms and the registration fee of $50 per child is due by Friday, May 3 to reserve my child's spot. If the registration is received after this date, it will be considered on a space available basis. My registration is not complete until this registration fee is received.

--A pre-pay deposit will be required for the estimated usage of one billing cycle. This deposit is due before Monday, June 3. This deposit will be applied to my final billing statement. Payments can be made by cash, check, or Electronic Funds Transfer (EFT).

The Childcare Director will reach out to you for any additional information that may be needed prior to the start of summer childcare.
To pay by EFT, please click the link in your confirmation e-mail.


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