Program  Acceptance Form

Date:___________________

This is to confirm that ___________________________________________________, has been

accepted for care by  the_______________________________Day Care and a place will be

reserved until the first day of care which is on __________________.

A  registration fee of $________.00 has been recieved.  This registration fee will not be returned in

the event that the child is not placed in our care.   Please note that we have a waiting list.  We can only

reserve your child a spot until the day in which your child is scheduled to start.

_________________________________

Parent / Guardian                              Date

_________________________________

Parent / Guardian                              Date

_________________________________

Director                                            Date