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10 W. 182nd Street                       Bronx, NY 10453                 Phone: (646) 314-7571

Better Days Before And After

Pre-Registration Form
Bold = Required field
Child's Name
Date of Birth
Sex
Present Age of Child
Potty Trained?
Pull-ups?
Brand of Diapers Used
Formula: Brand Used
Milk?
Lactose Intolerant?
Food Allergies
Program Selection/Type
Date and Time Day Care Needed
Parent / Guardian Name
Employer(s)
Address
Employer(s) Address
Contact Phone Number
Does/Can employee(s) contribute to flexible spending plan for dependent care?
Method of Payment
Private / Credit
From              To

May 1, 2008

Dear Prospective Parents:

Thank you for your interest in utilizing Better Days Before And After, for your child care needs.  Please complete the attached form (via e-mail or return it to us by regular mail) in its entirety and return it as promptly as possible. 

This $100.00 (submit through Pay Pal) non-refundable fee will be put towards your registration package at time of enrollment.  Please keep in mind that this deposit ensures you the next available slot in that age group for your child.  Please Note: A registration fee will only be accepted if there is a slot available in your child’s age group.

Upon receipt of your of your deposit, you will receive a receipt and an approximate date of enrollment for your child.  You will also receive an application and fee schedule at that time.

 Open House appointments will be scheduled in accordance to registration fees, if any slots are available thereafter, appointments will be made only for slots still remaining.

Thank you for your interest in our program and we look forward to having your child (ren) join us.

Sincerely,

 

Roslyn Gillespie
Administrative Director

For a printable version of this form, please click here.