Registration | Mary Poppins Daycare

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NEW SAFETY REGULATIONS We make sure your children are safe in our care.

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- Toddler Early Learning
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Phone

419-318-2844

Email

info.marypoppinsdaycare@gmail.com

Social Media

Child's Information

First Name

Birthday

Toilet Trained: *

Yes

No

Special services if yes, please specify

Speech/ Language Therapy

Special Instruction (SEIT

Occupational Therapy

Physical Therapy

Middle Name

Part Time

Full Time

Does your child suffer from allergies or medical conditions? *

Yes

No

Has your child previously attended a childcare program? *

Yes

No

Last Name

Projected date of enrollment:

If yes, please specify

If yes which one?

Parent's Information

First Name

Home Address

Middle Name

Email

Last Name

Phone Number

In case of emergency please contact:

First Name

Last Name

Phone Number

Full name of adult who is allowed to pick up child if parent cannot

Thanks for submitting!

Initial Registration Form

Please use this registration form if you are interested in having your child attend Mary Poppins Daycare & Nanny Services. Someone will reach out to you via phone or email within 24 hrs.

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