A completed registration form and $50.00 registration fee holds a spot for your child. All other paperwork and medical information must be on file a minimum of 24 hours before your child can attend. You can print this form and drop it off or mail with your check to: Stone Church Child Care 10737 West Orland Parkway, Orland Park, IL 60467. You will be contacted if there are no openings available.
Child's name: ________________________________ Birthday: ___________________
Nickname: __________________________________ Male/Female: ________________
Age at start date: ________________________ Grade at start date:_________________
Parent's Names: ___________________________________________________________
Daytime phone: _________________________ Evening Phone: ___________________
Usual pick-up person: ________________________________________________________
Scheduled arrival time: __________________ Scheduled departure time: ______________
Name of other persons paying for child care: ______________________________________
Special instructions (Allergies): _________________________________________________
Fall session and/or Summer session
Child Care: M TU W TH F Kindergarten Before/After care: M TU W TH F
Preschool: M TU W TH F 1st - 6th Grade Before/After care: M TU W TH F
How did you hear about the center? _______________________________________________
-----------------------------For office use only - Do not write below this line -------------------------------
Payment Received: $50.00 Cash/Check#_______________ Receipt# ____________________
Authorized by: ______________________ Date application taken: _____________________
Class assigned: ______________________ Starting Date: _____________________________