Registration – Fantasija Child Care Centre

Registration Form

Child Name

Child Surname

Date of Birth

Address Line 1

Address Line 2

ID Card

Weeks born at

Languages Spoken at home

Parent 1 Name

Parent 1 Surname

Phone / Mobile

Parent 1 Email

Address Line 1

Address Line 2

Parent 1 ID Card

Type of Employment

Medical History of ilnesses, disabilities or conditions.

Parent 2 Name

Parent 2 Surname

Phone / Mobile

Parent 2 Email

Address Line 1

Address Line 2

Parent 2 ID Card

Type of Employment

Medical History of ilnesses, disabilities or conditions.

Does the Child suffer from any Allergies or Medical Conditions?

Yes No

Please give details

Do you want to add something about your child?

Select Child Care Centre