Childcare Enrollment Form

For Returning Families

Child's Full Name

Sex assigned at Birth

Female

Male

Birth date

Full Name Parent 1

Full Mailing Address (Street City State Zip)

Parent 1 Phone

Email Parent 1

Employer Parent 1

Work Phone Parent 1

Full Name Parent 2

Full Mailing Address for Parent 2

Parent 2 Phone

Email Parent 2

Employer Parent 2

Please list names, birthdates and relationships of other household members

What languages are spoken in your home?

Please rank the care you would prefer from 1-4. 1 is your first preference and 4 your last. You must choose at least one. Put 0 for any that you do not want. Please note all times are 8am-4pm. We will do our best to match your preference with the available slots.

Sept to Aug, Monday-Thursday

Sept to Aug, Monday-Friday

Sept to June, Monday-Thursday

Sept to June, Monday-Friday

We are looking at the possibility of offering limited slots for an early drop off of 7:45am for an extra $25 per week. Is this something that would be helpful for your family.

Yes

What inspires you to have your child remain in Sophia's Hearth Early Childhood Care & Education Program?

Are you currently planning on staying with Sophia's Hearth to the contract end date of August 31, 2026?

Yes

If No, What is your estimated date you would end care with Sophia's Hearth? *Please note this question is non-binding.

Does your child have any medical conditions or allergies?

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

Your Signature

A payment of $100 for your re-enrollment deposit must accompany this form submission. The $100 deposit will not be refundable until the contract starts and will then be held to apply to the final weeks of tuition.

Thank you. The form is complete.

After clicking the "proceed to pay deposit" button a pop up screen will appear to complete the payment. It sometimes takes up to 10 seconds so please be patient. The form will not be submitted unless the fee is paid.

Payment can be made by Mastercard, Visa, Discover, Amex, or PayPal.