Childcare/Latchkey Registration Form
PLEASE NOTE: New registrations require a $25 deposit (per child) due in person via cash, check or money order made out to Imlay City Schools.
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Email *
Child’s Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Gender *
Grade *
School *
Teacher *
Father/Legal Guardian Full Name
Mother/Legal Guardian Full Name
Marital Status *
Siblings (Names & Ages) *
If none, please specify none
Custody Information
Have there been any major changes in your child’s life recently? *
Examples: Moving, new custody arrangement, new sibling, etc.
If yes, please explain:
My child's greatest fears are: *
When angry, my child will: *
My child has difficulty with: *
1. Does your child have an IEP? *
Individualized Education Plan
2. Does your child have a 504 Plan? *
3. Does your child have any other specialized education plan on file with the school? *
If you answered yes to questions 1 - 3 above, please explain:
Please use the space below to provide us with any other information that would be helpful for us to know about your child. *
If your child is 2.5 – 5 years, has he/she ever attended a childcare or preschool program? *
If yes, where did your child attend?
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