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Summer Camp Registration Form
Unique Blessings Learning Center, LLC 4851 6th Street, Zephyrhills, FL 33542
NOW OPEN AND ACCEPTING ENROLLMENT FOR INFANT THROUGH VPK & FAMILY READINESS
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Email
*
Your email
Our Summer Camp begins June 6th and ends July 29th. What type of child care do you need?
*
Summer Camp Hours 9am-2pm
Before care with Summer Camp Hours 7am-2pm
After care with Summer Camp Hours 9am-5pm
Both Before and After Care with Summer Camp Hours 7am-5pm
Child care start time
Time
:
AM
PM
Child care end time
Time
:
AM
PM
How many children do you need care for?
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1
2
3
4
5
What ages do you need care for?
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Infant 0 months-11 months
Toddler 13 months-23 months
3 year old
4 year old
School age
Required
What is the name and birthdate of child #1
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Your answer
What is the name and birthdate of child #2
*
Your answer
What is the name and birthdate of child #3
Your answer
Do you qualify for Family Readiness (Early Learning Coalition)-low income family subsidy?
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Yes
No
I am not sure
Does any of your children have severe allergies to foods?
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Yes
No
Please leave your name below:
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Your answer
Please leave your email address below:
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Your answer
Please leave your contact phone number below:
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Your answer
Please leave legal guardians name/s?
*
Your answer
What is the primary address for the child?
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Your answer
Have you completed our enrollment packet, submitted child's FL HEALTH CARD-School Entry Form, and Shot Record or exemption letter from the Department of Health? This must be done for child to be enrolled.
*
Yes
No
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