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Type of Care Your Enrolling In(Required)

Full Time – $100 holding fee due upon completion of this form

Part Time – $100 holding fee due upon completion of this form

Flexible Care Full Days- No holding fee

Flexible Care Part Time Days- No holding fee

PERSONAL DETAILS AND DESCRIPTION

Child's First Name:(Required)

Date of Birth:(Required)

MM slash DD slash YYYY

Child's Last Name:(Required)

Desired Date of Admission:(Required)

MM slash DD slash YYYY

Gender:(Required)

Male

Female

ICCP

Yes

Child Age

DAYS PLANNING TO ATTEND (Full or Part time)

Monday

Tuesday

Wednesday

Thursday

Friday

Sibling Attending:

If using planning to use Flexible scheduling: average days a week

Allergies/Special Diets:

Home Address:(Required)

City:(Required)

Zip:(Required)

PARENT/GUARDIAN INFO – Both will receive a text invite to download our Brightwheel App for secure pick up and drop off

Primary Parent/Guardian:(Required)

First Last

Relation:(Required)

Email Address:(Required)

Phone #:(Required)

Home Address (if different):

This person will be primarily or sometimes…

Second Parent/Guardian:

Relation:

Email Address:

Phone #:

This person will be primarily or sometimes…

Home Address (if different):

Vaccination records(Required)

I have uploaded my records below

I will email copies to jabberskids@gmail.com

Please provide a vaccination waiver with drop off

Immunization Records

Drop files here or

Max. file size: 4 MB.

You may also sign a waiver in person at the first drop off if your child is not immunized.

CHILD DEVELOPMENT INFO

DOES YOUR CHILD?

Have eating issues(Required)

Yes

Have speech difficulties(Required)

Yes

*Use a pacifier or suck a thumb(Required)

Yes

Have a fussy time(Required)

Yes

How do you handle Fussy Times?

Health

Physical Conditions / Disabilities(Required)

Yes

If Yes, please list(Required)

Any Regular Medications(Required)

Yes

If Yes, please list(Required)

Eating and Toilet Habits

EATING HABITS

Special Characteristics / Difficulties

Describe your child's eating habits

Favorite Foods

Foods Refused

Anything you do not want us giving your child (i.e sugar, juice, chips)

What does your child eat with

Spoon

Fork

Hands

TOILET HABITS

Is your child currently in diapers?(Required)

Yes

Pull Ups – potty training

How often does your child use the toilet?(Required)

Does your child need frequent reminders?(Required)

Yes

Does your child need help wiping?(Required)

Yes

How many bowel movements per day

*Are Bowel movements regular?

Yes

*Any concerns about diarrhea?

Yes

*Any concerns about constipation?

Yes

Is your child fully potty trained and asking to use the restroom when needed?(Required)

Yes

How does your child indicate bathroom needs (include special words):

Is your child ever reluctant to use the bathroom?

Yes

What is used at home?

Potty Chair

Special Child Seat

Regular Seat

Does your child have accidents?(Required)

Yes

Additional concerns:

Additional Child Info

SOCIAL RELATIONSHIPS

How would you describe your child's personality?(Required)

Previous experience with childcare(Required)

Reaction to strangers

Able to play alone?(Required)

Favorite toys & activities

Fears (dark / animals etc.)

How do you comfort your child

Behavior Management method at home

How do you want us to comfort your child?

SLEEPING HABITS

Does your child have a time of the day they they get tired or need down/quiet time?

Does your child nap during the day at home?(Required)

If yes, how long

Describe any special characteristics or sleeping needs (stuffed animal, story, mood on waking, etc.):

PLEASE NOTE

Jabbers Kids does not have a scheduled nap time during the day, however, we do accommodate tired children with a quiet and dark space to take a nap in the chance that they require one.

Emergency Contact/Authorized

EMERGENCY CONTACT/AUTHORIZED PICK-UP PERSON

If there’s an emergency situation where I cannot be reached, the Educator is authorized to contact the following individuals (in the listed order) to collect my child from the child care facility. The following are authorized to pick up my child. This person will receive a text inviting them to our Brightwheel App.

1 – ONE

Full Name:(Required)

Telephone #:(Required)

Relation:

This person will be primarily or sometimes…

2 – TWO

Full Name:

Telephone #:

Relation:

This person will be primarily or sometimes…

3 – THREE

Full Name:

Telephone #:

Relation:

This person will be primarily or sometimes…

4 – FOUR

Full Name:

Telephone #:

Relation:

This person will be primarily or sometimes…

PARENT CONSENT(Required)

I agree to the privacy policy.

I, the undersigned, hereby consent to enroll my child at Jabbers Kids Daycare. I authorize Jabbers Kids and its staff to provide care, guidance, and supervision for my child while attending the daycare. I understand that the daycare staff will take all necessary precautions to ensure my child’s safety and well-being.

PAYMENT AND LOGIN INFO

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Create a username and password which can be used to schedule flexible care here on our website.

Email:(Required)

Password(Required)

Enter Password Confirm Password

Untitled

First Choice

Second Choice

Third Choice

Enrollment Forms

PERSONAL DETAILS AND DESCRIPTION

DAYS PLANNING TO ATTEND (Full or Part time)

PARENT/GUARDIAN INFO – Both will receive a text invite to download our Brightwheel App for secure pick up and drop off

CHILD DEVELOPMENT INFO

DOES YOUR CHILD?

Health

Eating and Toilet Habits

EATING HABITS

TOILET HABITS

Additional Child Info

SOCIAL RELATIONSHIPS

SLEEPING HABITS

PLEASE NOTE

Emergency Contact/Authorized

EMERGENCY CONTACT/AUTHORIZED PICK-UP PERSON

1 – ONE

2 – TWO

3 – THREE

4 – FOUR

PAYMENT AND LOGIN INFO