New Life Harvest Church - Registration for Day Care - Richmond, VA
New Life Harvest Church - "We are saving and strengthening families."
 
NextGen Learning Center Spring  2011
 
Day Care & Before and Afterschool Program
 
 
 
 
 
 
 
Opening Date:  September 7, 2010
Time: 6:30 AM - 5:30 PM
Monday - Friday
Location:
133 E. Belt Blvd, Suite D
Richmond, VA 23224
Call: (804) 665-7674
 
 
 
 
 
 
Fun Daily Activities!
 Caring Environment!
Life Lessons Learned!
Breakfast and Lunch Provided! 
 
 
 
Please Be Sure to Fill Out Our Online Application After Payment is Made or Call us at 804-426-5314
 
*An Application Must Be Completed for Each Child*
 
 
Day Care 2011 Application
List Names of Children and Ages
Date of Birth of Children
Name
Address
Birthdate
Age of Child
Home Phone
City
State
Zipcode
Father's Name
Employer
Work Phone
Cell Phone
Mother's Name
Employer
Work Phone
Email
Medical
Physician's Name
Phone
Is your child on medication that we need to know about?
Yes or No
Yes
No
If yes, please explain:
In case of emergency, contact:
Relationship to student:
Your child will be released only to the parents/ guardian or the following persons(s)
Phone
Cell Phone
Your child will be released only to the parents/ guardian or the following persons(s)
Phone
Cell Phone
Parent Agreement and Consent
1. I understand that the tuition Day Care Program is based on age of child and availability and is Non-Refundable once the program starts.
Check Here
Yes
No
2. I understand that the Day Care Program will be open Monday-Friday, 6:30a.m.to 5:30 p.m., and will be closed for Holidays.
Check Yes or No
Yes
No
3. My child has permission to participate in field trips and swimming activities; and can be transported by Day Care Program Staff.
Check Yes or No
Yes
No
4. In the event of an emergency, the staff of the Day Care Program may administer first aid to my child or obtain emergency treatment, if necessary. I also understand that the staff can only administer dated, labeled and prescribed medication. I realize that I must leave written permission before my child can be administered his/her medication.
Check Yes or No
Yes
No
Certification: I certify that I have read and understand this application.
Signature (Print Name Here)
Date
 
 
 
 
 
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