Telephone Inquiry

Date:_______________________Time:________________________Home Phone____________________

Heard about our day care from:

Parent(s) Name:________________________________________________________________________

Home Address:_________________________________________________________________________

Employer :_____________________________________________________________________________

Work Phone:__________________________________________________________________________

Child's Name:___________________________________________Age:_______________Sex:

Days : Mon. Tues. Wed. Thurs. Fri. Sat. Sun.   Drop-Off Aprox.__________Pick-up Aprox._________

Start Date Needed:________________________________Has child ever been in day care?____yes ___no

Comments:___________________________________________________________________________

___________________________________________________________________________________

Interview Date :_______________________________Interview Time:_____________________________

Friend

Family

Ad

Passed by

Other________

F

M

Full Time

Part Time