Registration | Tiny Tides Daycare

Child's First Name

Child's Last Name

Date of Birth

Year

Month

Day

Age

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone

Address

Country/Region

Address

City

Zip / Postal code

Relationship to Child

Emergency Contact Name

Emergency Contact Phone

Authorized Pick-Up Person 1 Name

Authorized Pick-Up Person 1 Phone

Authorized Pick-Up Person 1 Relationship

Authorized Pick-Up Person 2 Name

Authorized Pick-Up Person 2 Phone

Authorized Pick-Up Person 2 Relationship

Doctor's Name

Doctor's Phone

Allergies (food, medication, etc.)

Special Needs/Conditions

Medication Required

Immunizations up to date?

Yes

If Yes, please explain

Does your child nap during the day?

Yes

Any fears or comfort items (e.g., blanket, toy)?

Language(s) spoken at home

Anything else you'd like us to know about your child

I certify that the information provided is accurate and complete to the best of my knowledge. I agree to notify Tiny Tides Daycare of any changes. I understand and agree to abide by the policies and procedures of the daycare.

Signature of Parent/Guardian

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Date

Year

Month

Day