Enrollment Application

Which facility are you interested in? Check all that apply, note: applying for more than one home will increase your opportunity for timely enrollment.)


BurlingameSW PortlandConcordiaPiedmont



Requested Starting Date :



How did you hear about My Bundle of Joy?



Note: If your child has not yet arrived, you need only fill out the sections you do know currently.



Child’s Name



Birth Date Or Due Date



Home Address



City Zip



Home Phone







Parent's Name



Cell



Email



Employer



Profession



Position



How Long?








Parent's Name



Cell



Email



Employer



Profession



Position



How Long?



Is this your : First ChildSecond ChildThird Child



Do any physical limitations, special requirements or allergies exist that we should be aware of to better care for your child?



Do you have any religious/spiritual/other beliefs that would require our attention?



Will you be providing breast milk? YesNo



Does your child drink well from a bottle? YesNoJust LearningHas not tried yet



Is your child a vegetarian? YesNo



Are there any foods your child does not like?



What hours will you normally need?



Tell us about your child’s current daily nap schedule.



Is this your first experience with daycare? YesNo



If no, why are you making a change?



What are your expectations of your care providers?



We would like our child to be considered for enrollment at My Bundle of Joy. We understand the rates, hours, holiday/vacation schedule and that an in-person interview, with both of us and our baby, is part of the enrollment process. We also understand that a deposit, equal to one month’s fees, will be required upon enrollment. Note: There is no fee to submit this application for the wait-list.



Parent Signature:



Parent Signature: