SRA - Child Care Application for Enrollment

Section 65 C-22.006(2), F.A.C., requires a current physical examination (Form 3040) and immunization record (Form 680 or 681) within 30 days of enrollment. ( For Kids less than age 5, submitting physical examination and immunization record is mandatory. Not required for school age kids. ) Section 402.3125(5), F.S., requires that parents receive a copy of the Child Care Facility Brochure, "KNOW YOUR CHILD CARE FACILITY"(www.shivarobotics.com/brochure.html) Section 65C-22.006(4) (c)., requires that parents are notified in writing of the disciplinary practices(http://www.shivarobotics.com/discipline-policy.html) used by the child care facility. Your signature below indicates that you have received the above items and that all information on this enrollment form is complete and accurate. Please type your name to sign *

STATE OF FLORIDA - DEPARMENT OF CHILDREN AND FAMILIES
CHILD CARE APPLICATION FOR ENROLLMENT

Student Information :

Preferred Class Timing :

Family Information

Medical Information

Contacts :

We Would Love to Have You Visit Soon!

Hours

Telephone

Email

STATE OF FLORIDA - DEPARMENT OF CHILDREN AND FAMILIESCHILD CARE APPLICATION FOR ENROLLMENT