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BABY UNIVERSITY
Application for Child Care Center
Please complete the form to apply for Voice of Hope Child Care Center. If any required questions are left blank or if a question is answered incorrectly the form will show the errors before it will be submitted.
*
Indicates required field
Child's Full Name
*
First
Last
Untitled
*
Preferred Email
*
Child lives with
*
Both Parents
Mom
Dad
Grandparents
Other Relative
Child's Date of Birth mo/day/year
*
Name of Parent or Guardian Completing the Form
*
First
Last
Contact Phone Number 1
*
Contact Phone Number 2
*
I authorize the child care provider to release my child to leave the child care operation ONLY with the following persons. Please list name and phone number of each. Children will only be released to a parent or guardian or to a person designated by the parent/guardian after verification of ID.
Name of First Authorized person
*
First
Last
[object Object]
Phone Number of first authorized person
*
Name of Second authorized person
*
First
Last
Phone Number of second authorized person
*
Name of third authorized person
*
First
Last
Phone Number of third authorized person
*
Preferred Phone Number
*
Address where child lives
*
Line 1
Line 2
City
State
Zip Code
Country
Address of Parent or Guardian Completing the Form
*
Line 1
Line 2
City
State
Zip Code
Country
Name of Emergency Contact
*
First
Last
Phone Number for Emergency Contact
*
Relationship to Emergency Contact
*
Address for Emergency Contact
*
Line 1
Line 2
City
State
Zip Code
Country
I agree to receiving marketing and promotional materials
Submit
Home
About Us
Programs
Summer Day Camp
ASPIRE
>
Gradus
Grand Prairie
West Dallas
ECEC
Community
Parent Payment
Donate Now
Volunteer
Volunteer Application
Volunteer Boards
News & Events
Blog Stories
Job Opportunities
UA-103966823-1
