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

    Student Information :

    Preferred Class Timing : 

    Family Information



    Medical Information

    I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.

    Contacts :

    Child will be released only to the custodial parent or legal guardian and the person listed below.  The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached :

    Max file size: 20MB
    Please upload a clear picture of your child.
    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" Section 65C-22.006(4) (c)., requires that parents are notified in writing of the disciplinary practices 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.
Submit

We Would Love to Have You Visit US Soon!


Hours

Wednesday: 4 - 7 pm
Sat : 10 am to noon

Telephone

904-704-7046

Email

build@ShivaRobotics.com
  • Home
  • About us
    • Our Story
    • Awards
    • Media Room >
      • Media Kit
      • Press
      • Gallery
  • Programs
    • Robotics Class - After-School/Weekend >
      • Robotics Class Information
      • Recreational Robotics Class Rates
    • Competitive Teams >
      • Junior Team
      • Senior Team
    • SPRING CAMP
    • SUMMER CAMP
    • Robotics Workshop
    • Birthday Parties
    • School Field Trips
  • Application for Enrollment
  • Blog
  • Online Store
  • We are Hiring
  • Franchising
  • FLL Jr Expo Registration
  • Network
  • Testimonials
  • Contact Us
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