daycare form FOR SITE

ACADÉMIE
FIRSTSTEPS
P R E M I E R S PA S
ACADEMY
INFORMATION DE L'ENFANT/CHILD INFORMATION
PRÉNOM/FIRST NAME
NOM DE FAMILLE /FAMILY NAME
DATE DE NAISSANCE/DATE OF BIRTH
M
M/Y
J/D
INFORMATION DU PARENT/PARENT INFORMATION
MOTHER
FATHER
FAMILY NAME
FAMILY NAME
GIVEN NAME
GIVEN NAME
CELL PHONE
HOME PHONE
CELL PHONE
HOME PHONE
WORK PHONE
WORK PHONE
EMAIL
EMAIL
DATE DE COMMENCEMENT/START DATE:
M
M/Y
J/D
RÉSERVÉ AU BUREAU/FOR OFFICE USE ONLY
DATE DE CONTACT/CONTACT
M
J/D
M/Y
CONTACTÉ PAR/CONTACTED BY:
DATE L'ESPACE EST DISPONIBLE/DATE SPACE IS AVAILABLE:
ACCEPTÉ/ACCEPTED
YES
NO
M
J/D
M/Y