Intake form

Name *

Email address *

Child's age

Preferred start date

Parent/Guardian's phone number

Does your child have any allergies?

Please select at least one option.

No allergies

Peanut allergy

Dairy allergy

Gluten allergy

Egg allergy

What are your child's interests?

Please select at least one option.

Arts and Crafts

Music

Outdoor Activities

Reading

Science

Building/Construction

Imaginative Play

Emergency contact name

Emergency contact phone number

Is your child currently enrolled in another daycare or preschool?

If yes, please provide the name of the daycare or preschool

How did you hear about the tots spot?

Please select at least one option.

Friend/Family

Social Media

Online Search

Community Event

Additional questions or comments

The Tots Spot