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| SNOW DAY CARE APPLICATION/DROP-IN CARE APPLICATION | |||||||||||
PENN CHILDREN'S CENTER
3160 Chestnut Street, Suite 100 Application for SNOW DAY CHILD CARE ______ Application for DROP-IN CARE ______ Day(s) your child will attend: ____Mon.____Tues.____Wed. ____Thurs.____Fri. *Please check all that apply Date(s) care is required: _______________________________________________ *Dates listed will have to be verified by center staff Child’s Name _______________________________________________ Date of Birth _____________ Present Age _______________ Address _______________________________________________ City ____________________ State ____________ Zip __________ Telephone (include area code) ___________________________ Who will be responsible for bringing your child(ren) to the Center? Name _____________________________ Relationship _____________ Time your child(ren) will arrive at the Center __________________ and depart from the Center _______________________ General health _____________________________________________________ Please indicate any allergies, medications, special needs or limitations: _________________________________________________________________________ Does your child have any dietary need? Food allergies? _______________________________ __________________________________________________________________________ Mother’s Name _______________________________________________ Mother’s Business Address _______________________________________________ Mother’s Business Phone Number (include area code) ________________________ Father’s Name _______________________________________________________ Father’s Business Address _______________________________________________ Father’s Business Phone Number (include area code) ________________________ If you will be attending an activity on campus, please give the location and telephone number: ______________________________________________________________________ Is your child toitlet-trained? _______________________________________________ Does your child nap? _________ If yes, how long? _____________________________ Other Required Forms: Please contact the center for HEALTH ASSESSMENT and EMERGENCY CONTACT forms! Thank you! ________________________________________ Please note: Your application will not be complete unless you have the application, health form and emergency contact/parental consent form completely filled out, signed where appropriate and on file at the center. FOR DROP IN CARE FEES, PLEASE SEE THE TUITION FEE SCHEDULE BY CLICKING HERE. Fee Schedule for Snow Day Child Care is listed below
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