Enrollment Application Requested Start Date * MM DD YYYY How did you hear about Irving Day Nursery Note: If your child has not yet arrived, you need only fill out the sections you do know currently. Child's Name * Child's Birthdate MM DD YYYY or Child's Due Date MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Parent/Guardian Information Parent/Guardian Name * First Name Last Name Parent/Guardian Email * Parent/Guardian Employer * Parent's/Guardian's Profession * Parent/Guardian Position * Second Parent/Guardian Name (optional) First Name Last Name Second Parent's Email Second Parent's Employer Second Parent/Guardian's Profession Second Parent's Position Child Information Is this your First Child Second Child Third Child Fourth Child Do any physical limitations, special requirements or allergies exist that we should be aware of to better care for your child? Do you have any religious/spiritual/other beliefs that would require our attention? Will you be providing breast milk? Yes No Does your child drink from a bottle? Yes No Just Learning Has not tried Is your child a vegetarian? Yes No Are there any foods your child does not like? What hours will you normally need? And what days will you need? Tell us about your child’s current daily nap schedule. Is this your first experience with daycare? Yes No If no, why are you making a change? What are your expectations of your care providers? Request for Enrollment We would like our child to be considered for enrollment at Irvington Day Nursery. We understand the tuition rates, hours of operation, holiday schedule, and that an in-person tour and meeting—with both parents and our child (if born)—is an important part of the enrollment process. We also acknowledge that a $100 annual registration fee and deposit equal to one month’s tuition will be required upon enrollment. (There is no fee to submit this application to join the waitlist.) Parent Signature * Parent 2 Signature Thank you!
