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Little U Information Form

Please fill out the form, a * indicates a required field.

ENTER YOUR INFORMATION IN THE FORM BELOW:

Parent/Guardian's Name: *

Home Address: *

Phone Number: *

Cell Number: *

Child #1 Name, Date of Birth, & Age: *

Child #2 Name, Date of Birth, & Age:

Child #3 Name, Date of Birth, & Age:


Is he/she currently in childcare/preschool? Yes No

If yes, where?

Reason for leaving?

Was he/she previously in childcare/preschool? Yes No

If yes, where?

Reason for leaving?


Where did you hear about Little U? *

Days needed at Little U? *

What hours?

What date would you like to start at Little U?

Is your child fully potty trained? Yes No

Any allergies?

Any special instructions?