# Childcare enrollment form and agreement

Source: https://backpr.com/resources/templates/child-care-enrollment-form. Last updated: 2026-10-22.

An enrollment form and parent agreement for daycares and childcare centers: child and family details, schedule, key policies and signatures.

Free download: PDF https://backpr.com/media/templates/backpr-child-care-enrollment-form.pdf · Word https://backpr.com/media/templates/backpr-child-care-enrollment-form.docx

> Fill in the [bracketed] details, delete what doesn't apply and make sure the policies here match your parent handbook. Check your state's licensing rules for what an enrollment record must include, and have a lawyer review the agreement before families sign it.

**Program (filled in by the program)**
- Program name and license number (if licensed): ______
- Address and phone: ______
- Director or provider: ______
- Hours we're open: ______
- Holidays and other days we're closed: ______

**Child**
Please fill out one form for each child.
- Full name: ______
- Name they go by: ______
- Date of birth: ______
- Languages spoken at home: ______
- Start date: ______

**Parent or guardian 1**
- Name: ______
- Relationship to child: ______
- Cell phone: ______
- Email: ______
- Address: ______
- Workplace and work phone: ______

**Parent or guardian 2**
- Name: ______
- Relationship to child: ______
- Cell phone: ______
- Email: ______
- Address (if different): ______
- Workplace and work phone: ______

**Custody and court orders**
If a court order limits a parent's or guardian's access to this child, such as a custody or protective order, attach a copy. Without one, we may not be able to refuse pickup by a parent or guardian.
- [ ] A copy of a court order is attached

**Schedule**
Check the days your child will attend. Please tell us in writing at least [number] days ahead if your schedule needs to change. Changes depend on space and may change your tuition.
- [ ] Monday
- [ ] Tuesday
- [ ] Wednesday
- [ ] Thursday
- [ ] Friday
- Usual drop-off time: ______
- Usual pickup time: ______
- Full-time or part-time: ______
- Other days or a schedule that changes (such as for shift work): ______

**Emergency contacts (other than parents)**
An emergency contact can pick up your child only if they're also on your authorized pickup form.
- Name, relationship, phone: ______
- Name, relationship, phone: ______

**Health basics**
Please also fill out the health forms on the checklist below, and tell us right away if anything changes.
- Allergies (and how serious): ______
- Medications: ______
- Health conditions or special needs staff should know about: ______
- Child's health care provider and phone: ______
- Health insurance company and policy or member ID: ______

**Forms we need before the first day (filled in by the program)**
We'll check off each form when we receive it.
- [ ] Immunization and health record
- [ ] Authorized pickup form
- [ ] Medical and allergy form (if your child has allergies, medications or health needs)
- [ ] Tuition and fee agreement
- [ ] Infant feeding plan (for babies)
- [ ] Photo and media release
- [ ] Sunscreen and insect repellent permission
- [ ] Parent handbook acknowledgment
- [ ] [Other forms your state requires]

**Our policies**
By signing, you agree to these policies. Our parent handbook explains each one in more detail.
- Drop-off and pickup: Please sign your child in and out each day. We release children only to parents, guardians and adults on their authorized pickup list, and staff check photo ID for anyone they don't know. Late pickup: [policy and fee].
- Illness: Please follow our sick child policy. If we call to say your child is sick, someone must pick them up within [time].
- Medicine: Staff give medicine only with a signed medication authorization form, with the medicine in its original labeled container.
- Tuition and fees: as set out in our tuition and fee agreement.
- Visits: Parents and guardians are welcome to visit any time their child is here, unless a court order limits their access. [Any sign-in rule for visitors.]
- Behavior: We use positive guidance: clear expectations, praise and redirection. We never use physical punishment, shaming or withholding food.
- Child protection: All staff [and regular volunteers] pass a background check and are trained to spot and report suspected abuse or neglect. Staff report concerns as [state] rules require.
- Closures: We close for [holidays] and when [conditions, such as severe weather]. We'll tell families by [text, email or phone] by [time].
- Leaving the program: Please give us [number] weeks' written notice before your child's last day. Our tuition and fee agreement explains what's due during the notice period.
- Ending care: If we need to end care, we'll give you [number] weeks' written notice, unless a child's or staff member's safety is at risk. We'll talk with you first whenever we can.

**Consent for emergency care**
In an emergency, staff will call 911 if needed and contact me as soon as they can. If they can't reach me, I authorize program staff to get emergency medical care for my child, including ambulance transport and treatment by a doctor or hospital, and to share this form with the medical staff who treat my child.

**Signatures**
I have read and agree to this enrollment agreement and the program's policies, and I give the consent for emergency care above. The information on this form is correct, and I'll tell the program right away if anything changes.
- Parent or guardian 1 printed name: ______
- Parent or guardian 1 signature and date: ______
- Parent or guardian 2 printed name: ______
- Parent or guardian 2 signature and date: ______
- Director or provider signature and date: ______

### How to use it
- Have a lawyer review the agreement before you use it, especially the parts on notice, ending care and court orders. Rules on contracts and childcare vary by state.
- Use the same wording here as in your parent handbook, tuition agreement and sick child policy, so nothing contradicts.
- Collect every form on the checklist before the first day, not at drop-off, and ask families to review the enrollment form each year and whenever something changes.
- Before you end care because of a child's behavior or health needs, talk with the family and get advice. Disability rights laws, such as the Americans with Disabilities Act, may apply.
- Check your state's licensing rules for what an enrollment record must include and how long to keep it. Find your state's rules at backpr.com/resources/states.

**What should a daycare enrollment form include?**
The child's and parents' details, the schedule, emergency contacts, basic health information, the forms you need before the first day, your key policies, consent for emergency care and signatures from the family and the program. Your state's licensing rules may require more.

**Should a lawyer review our enrollment agreement?**
Yes, it's a good idea. The agreement sets out what your program and each family promise each other, including notice periods and when you may end care, and rules vary by state. Have a lawyer review it once, then use the same version for every family.

Free to use and change, but not legal or medical advice. Check your state's licensing rules and your insurer's requirements, and have a lawyer review any consent or waiver language.