Anna's Bananas Daycare and Preschool Enrollment Form



Welcome to the start page of our enrollment form. This form uses cookies to remember your browser, in case you need to come back later to finish filling out the form. If you wish to continue from another computer, or if your browser clears its cookies when restarted, you may resume filling out your form by entering in your childs names and birthdate. These values must match EXACTLY to be able to recall saved information. This option will be available until you complete the registration form.

You MUST use a computer to complete the registration packet with the preferred browser being that of Google Chrome. This packet will not submit if you utilize a cell phone and you will find in the end that you receive continuous error messages. Prior to beginning it is important that you have the following information on hand to ensure your registration process goes smoothly:

1. Full Name (First, Middle, Last) of your child
2. Date of birth / Due Date
3. Your plan for attendance (Days of the week and approximate drop off and pick up times)
4. Parent Guardian information which includes First and Last name, complete address (house number, street number, street name, city, state, zip code), telephone number or numbers where you can be reached.
5. Your child's medical source which includes, name of the facility, complete address (business number, street number, street name, city, state, zip code), and a telephone number.
6. Your child's dental source which includes name of the facility, complete address (business number, street number, street name, city, state, zip code), and a telephone number.
**If your child does not yet see a dentist, you are still required to select what your preference would be or what you as a family may currently use**
7. Emergency medical source which includes, name of the facility, complete address (business number, street number, street name, city, state, zip code), and a telephone number.
**If you wish for us to use the closest, please list the closest medical facility to your location and include all pertinent address information**
8. At least TWO emergency contacts which include their first and last name, complete address (house number, street number, street name, city, state, zip code), and a telephone number.

Child's Name:
FirstMiddleLast
Birthdate \ Due Date
Child is unborn, date above is due date.