Enrollment Form

Hayat children’s center

13100-diamond hill drive

Germantown, md. 20874

Date to be enrolled                          _______________________________

Child's Name                                    _______________________________

Name used at home                        _______________________________

Date of birth                                     _______________________________

Present age                                       _______________________________

               Sex                                                      MF

Address                                                _______________________________

                                                             _______________________________

 Phone                                                _______________________________

FAMILY INFORMATION

Father's name                                 _______________________________

Father's Occupation                       _______________________________

 Home Address                               _______________________________

                                                         _______________________________

 Business Address                             _______________________________

  Phone                                             _______________________________

Mother's name                                _______________________________

Mother's Occupation                      _______________________________

Business Address                              _______________________________

 Phone                                             _______________________________

Guardian's Name:                          _______________________________

Relationship to child:                       _______________________________

Business Address                              _______________________________

 Phone                                             _______________________________

Reservation Fee ------

Registration Fee -----

            Paid Amount ____________Date____________ Check Number: _____________

               Deposit: Amount _____________ Date _____________ Check Number ______________

Desired Registration (Please Select one)

                All Day: 6:30am to 6:30pm

                  Two years old 

                  Three years old

                  Four years old

             Before and after school

               Elementary School Your Child enrolled at: 

                                      _______________________________

                        Address _______________________________

                        Phone   _______________________________

                  Morning preschool program 

                Monday through Friday 9am to 12:45pm

Additional information about the child

is there anything else you would like to share with us about your child that could help us better understand him/her?

Addition information about the child:

Parent/Guardian Signature_______________

Date                                 _______________

Director’s Signature         __________________

Date                               

Please Call us for more information

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