Intake form

Help us serve you better

Name *

Email address *

Child's date of birth

Parent/Guardian's name

Relationship to child

Child's gender

Address

Phone number

Emergency contact name

Emergency contact phone number

Is your child currently enrolled in another daycare?

Does your child have any allergies or special needs?

Preferred start date

How did you hear about us?

Please select at least one option.

Social Media

Word of Mouth

Online Search

Community Event

Which service or services are you interested in?

Please select at least one option.

Nurturing child care

Developmental programs

Flexible enrollment options

Additional questions or comments

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Kids Paradise Daycare