Instructions

  1. Fill out this form online
  2. Print it and mail it in

CRAYONS REGISTRATION APPLICATION
Name of Child: Date of Application:
Address:
City: State:
Zip: Telephone:
 
Name of Mother:  
Address:
City: State:
Zip: Telephone:
 
Name of Father:  
Address:
City: State:
Zip: Telephone:
 
 
Persons To Contact Other Than Parent In An Emergency:
 
Name:  Telephone:  
Address:
City: State:
Zip: Telephone:
 
 
Name:  Telephone:  
Address:
City: State:
Zip: Telephone:
 
 
Recommended by:
 
Day of Attendance Requested:  M   T   W   TH   F   
Please Indicate Full or Half Days: Full Half  
I will Bring My Child to School At About: AM FM  
I will Pick My Child Up At About: AM FM  
 
 
Placement:  
 
A Registration Fee of $50 Must Accompany This Application.
 
  Make Check Payable to: "Crayons Child Care" 
  Paid: $  
 
  Signed:

______________________________________ 		    
  Parent or Guardian Signature    
 
 
Start Date:   End Date:    
To Print: Click here or Select File/Print from your Browser Menu.

Mail to:

Crayons Early Care & Education Center Inc.
3445 Post Road, Warwick, RI. 02886

CLOSE THIS WINDOW


 

3445 Post Road Warwick, Rhode Island 02886 p. 401 739 2700 e. info@trudeaucenter.org

© MMVIII J. Arthur Trudeau Memorial Center. All Rights Reserved.
Site Developed by Focus Business Solutions.