Early Childhood Care & Education Enrollment Update Form

For new children

Child's Full Name

Birth date required

Sex assigned at Birth

Female

Male

Please tell us about your child and your family:

Please share what inspires you to have your child in Sophia's Hearth Childcare Program.

Does your child have any medical conditions or allergies?

Has your child received any developmental evaluations? Is your child receiving any supportive services?

Please list previous and current care arrangements for your child (including dates).

Please describe your child's eating habits

Please describe your child's sleep habits.

Please describe where your child is in relationship to independent toileting (if applicable).

Your Signature

Thank you. The form is complete.