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Application for Childcare
Mother's First & Last Name
Father's First & Last Name
The child/children live with
Home Address
Parent Phone
Parent Email
How did you hear about Rachael's Daycare?
If you chose "Referral from current or past client" for the last question, please give me their name and address (if available):
Please select which daycare you would like more information about...
Rachael's Daycare LLC (Fishers - 141st/Cumberland)
Rachael's Daycare II LLC (Noblesville - 146th/37)
EITHER LOCATION WORKS
Child's Name
Child Information, please check what applies:
Male
Female
Twins
Triplets
Unknown
Child's current age category:
My Child's Birthdate or due date is:
SIBLING INFORMATION- If you have more than 1 child, please list their name, age, and date of birth below:
Your child's current daycare situation:
How long has your child attended their current daycare?
How many daycares has your child attended since birth?
Desired start date for childcare (If you are pregnant, please come up with your best guess for the start date):
Please note the days & hours you will need childcare:
Do you or your child have any special requests and/or concerns? Please list behavioral, emotional, and/or physical issues.
Are you familiar with the Indiana State Guidelines for Licensed Childcare Homes? http://www.in.gov/fssa/carefinder/2736.htm
Yes
No
Are you familiar with the "Paths to Quality" Program (PTQ)? http://childcareindiana.org/
Yes
No
Are you familiar with the NAFCC standards for National Accreditation? http://www.nafcc.org/file/35a7fee9-1ccf-4557-89d4-973daf84a052
Yes
No
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