REGISTRATION
FORM
Instructions: This form is to be filled up by the parent/guardian of the child upon
enrolment to the Child Development Center. This will kept by the Child
Development Teacher in the portfolio of the child.
Name: __________________________________________________________________ Sex: M____________ F____________
Address: ________________________________________________________________ Birthday: _______________________
Guardian: _______________________________________________________________ Relationship: ____________________
Registered: Yes No Age: ___________________________
Child’s First Language: ____________________________________________________ Second: _________________________
Guardian Information: E-mail Address: ______________________________
Mother
Name: __________________________________________________ Occupation: ____________________________________
Address: _______________________________________________________________________________________________
Contact Number: Home ___________________________________________ Work: ___________________________________
Father
Name: __________________________________________________ Occupation: _____________________________________
Address: _______________________________________________________________________________________________
Contact Number: Home ___________________________________________ Work: ___________________________________
IN CASE OF EMERGENCY, please contact the following:
Name: ___________________________________________________________________ Relationship: ___________________
Contact Number: Home ___________________________________________ Work: ___________________________________
Accomplished by: ________________________________________________ _____________________________
Signature over printed name of parent/ guardian Date
Reviewed by: ___________________________________________________ _____________________________
Signature over printed name of CDT Date
Registration Form