Childcare Enrolment Form Template

Childcare / daycare enrolment and intake form

This childcare enrolment form template gives a daycare or childcare centre one printable, fillable document to register a new child — child and guardian details, emergency contacts, authorized pickup, health information, and the daily-care details a classroom-only registration form does not ask for.

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How to use this template

• Complete one form per child before their first day of care, and keep it on file for the length of their enrolment.
• The form must be completed by a parent or guardian who holds legal parental responsibility for the child — they are the person authorised to give the consents in Section 8.
• Answer every Yes/No item; leave no consent line blank, since a blank line cannot be treated as agreement.
• Write “N/A” where a field genuinely does not apply (for example, a second guardian in a single-guardian household) rather than leaving it empty.
• List at least one adult, besides the guardians, who is authorized to collect the child — staff will ask to see photo ID at pickup for anyone not already known to them.
• Tell the centre immediately whenever any detail changes — especially contacts, allergies, medications, or who may collect the child.

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Section 1: Organisation & enrolment details

Organisation / centre name: [ORGANISATION NAME] Room / group: [ROOM OR GROUP] Requested start date: [REQUESTED START DATE] Attendance schedule (days and hours): [ATTENDANCE DAYS AND HOURS]

Filled in by the organisation or by staff at intake — identifies which room the child is joining and the schedule they will attend.

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Section 2: Child details

Full legal name: [CHILD FULL LEGAL NAME] Preferred name (if different): [CHILD PREFERRED NAME] Date of birth: [CHILD DATE OF BIRTH] Home address: [CHILD HOME ADDRESS] Language(s) spoken at home: [LANGUAGES SPOKEN AT HOME]

Enter the child’s identity exactly as it appears on official documents.

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Section 3: Parent / Guardian details

Guardian 1

Full name: [GUARDIAN 1 FULL NAME] Relationship to child: [GUARDIAN 1 RELATIONSHIP] Holds legal parental responsibility: ☐ Yes ☐ No Address: [GUARDIAN 1 ADDRESS] Mobile phone: [GUARDIAN 1 MOBILE] Email: [GUARDIAN 1 EMAIL]

Guardian 2 (if applicable)

Full name: [GUARDIAN 2 FULL NAME] Relationship to child: [GUARDIAN 2 RELATIONSHIP] Holds legal parental responsibility: ☐ Yes ☐ No Address: [GUARDIAN 2 ADDRESS] Mobile phone: [GUARDIAN 2 MOBILE] Email: [GUARDIAN 2 EMAIL]

A guardian must hold legal parental responsibility to give the consents in Section 8; leave Guardian 2 as “N/A” in a single-guardian household.

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Section 4: Emergency contacts

People to call if a guardian cannot be reached — do not repeat a guardian already listed above.

Emergency contact 1

Full name: [EMERGENCY CONTACT 1 NAME] Relationship to child: [EMERGENCY CONTACT 1 RELATIONSHIP] Phone: [EMERGENCY CONTACT 1 PHONE]

Emergency contact 2 (recommended)

Full name: [EMERGENCY CONTACT 2 NAME] Relationship to child: [EMERGENCY CONTACT 2 RELATIONSHIP] Phone: [EMERGENCY CONTACT 2 PHONE]

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Section 5: Authorized pickup persons

Adults, besides the guardians above, who may collect the child. Staff will check photo ID for anyone they do not already recognise.

Pickup person 1

Full name: [PICKUP PERSON 1 NAME] Relationship to child: [PICKUP PERSON 1 RELATIONSHIP] Phone: [PICKUP PERSON 1 PHONE]

Pickup person 2 (if applicable)

Full name: [PICKUP PERSON 2 NAME] Relationship to child: [PICKUP PERSON 2 RELATIONSHIP] Phone: [PICKUP PERSON 2 PHONE]

Custody or legal restrictions (if applicable)

Details of any court order or legal restriction on contact with, or pickup of, the child: [CUSTODY OR LEGAL RESTRICTION DETAILS — LEAVE BLANK IF NONE]

Leave blank if no restriction applies; if one does, attach a copy of the relevant order for the centre’s file.

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Section 6: Health & medical information

Known allergies (food, medication, environmental): [KNOWN ALLERGIES] Chronic conditions or additional needs: [CHRONIC CONDITIONS OR ADDITIONAL NEEDS] Current medications (name, dose, schedule): [CURRENT MEDICATIONS] Primary physician — name and phone: [PRIMARY PHYSICIAN NAME AND PHONE] Preferred hospital or emergency medical facility: [PREFERRED HOSPITAL OR EMERGENCY FACILITY] Immunization record on file: ☐ Yes ☐ No ☐ Not required in my area I authorize staff to seek emergency medical treatment for my child if I cannot be reached immediately: ☐ I authorize ☐ I do not authorize

Write “None” rather than leaving a medical field blank, so staff know it was seen and answered, not skipped.

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Section 7: Daily care preferences

Typical feeding schedule / formula or food notes: [FEEDING SCHEDULE OR FOOD NOTES] Typical nap schedule: [NAP SCHEDULE] Sunscreen application: ☐ I authorize ☐ I do not authorize Other daily-care notes (comfort item, toilet-training status, routines): [OTHER DAILY-CARE NOTES]

This section is what a childcare intake form needs beyond a school registration form — write “N/A” for any line that does not apply to your child’s age.

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Section 8: Consents, acknowledgement & signature

Photo/video use in the centre’s internal records (not public posting): ☐ I authorize ☐ I do not authorize I confirm I have received and reviewed the centre’s policies: ☐ Yes Guardian signature: [GUARDIAN SIGNATURE] Date: [SIGNATURE DATE]

The signing guardian must be the person named as holding legal parental responsibility in Section 3. For a full photo/video consent with publication and retention detail, use a dedicated photo/video consent form instead of this line alone.

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Section 9: For office use only

Date received: [DATE RECEIVED] Staff initials: [STAFF INITIALS]

Completed by the organisation at intake — not filled in by the family.