Enrollment | Amherst Baby & Childcare Center

Child's Name

Today's Date

Birthdate

Age

Gender

Male

Female

Start Date

Hours Attending

Child Resides With

Both Parents

Mother

Father

Other

Home Address

Phone

Mother's Name

Mother's Employer

Mother's Employer Phone

Ext

Father's Name

Father's Employer

Father's Employer Phone

Ext

Siblings Ages

Any Special Health Concerns?

Any medication taken regularly?

Any diagnosed allergies?

Takes Bottle

Naps

Potty Trained

Yes

No

Can your child communicate needs easily?

Yes

No

Has your child attended day care before?

Yes

No

Do you use babysitters?

Yes

No

Please list any interests or favorite toys

How Did You Hear About Us?

Why did you choose our center?

Signature

Date

Enrollment Form

Amherst Baby &
Child Care Center

4350 Millersport Hwy,
Buffalo, NY 14228

(716) 688-2068

Mon-Fri: 7am - 6pm

Enrollment Form

Amherst Baby & Child Care Center

4350 Millersport Hwy, Buffalo, NY 14228

(716) 688-2068

Mon-Fri: 7am - 6pm

Amherst Baby &
Child Care Center

4350 Millersport Hwy,
Buffalo, NY 14228