Enrollment ApplicationWhich facility are you interested in?* Burlingame SW Portland Concordia PiedmontCheck all that apply; please note that applying for more than one home will increase your opportunity for timely enrollmentRequested Starting Date* MM slash DD slash YYYY 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*Child's Birthdateor Child's Due DateHome Address* Street Address Address Line 2 City ZIP / Postal Code Phone Parent InformationParent's Name*Parent's Cell Phone*Parent's Email* Parent's Employer*Parent's Profession*Parent's Position* Second Parent's Name*Second Parent's Cell Phone*Second Parent's Email* Second Parent's Profession*Second Parent's Employer*Second Parent's Position* Child InformationIs this your First Child Second Child Third ChildDo 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? Yes NoDoes your child drink well from a bottle? Yes No Just Learning Has not triedIs your child a vegetarian? Yes NoAre 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? Yes NoIf no, why are you making a change?What are your expectations of your care providers? Request for EnrollmentWe 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. (There is no fee to submit this application for the wait-list.)Parent Signature*Parent 2 Signature*
