Noella's Clubhouse - Childcare - RocketCity.ONE

WELCOME TO NOELLA'S CLUBHOUSE: WHERE LITTLE STARS SHINE BRIGHT! 🌟

DISCOVER THE PERFECT PLACE FOR YOUR PRECIOUS ONES, AGED FROM INFANTS TO 4-YEAR-OLDS, WHERE LAUGHTER, LEARNING, PLAY, AND GROWTH COME TOGETHER IN HARMONY.

AT NOELLA'S CLUBHOUSE, WE'RE DEDICATED TO PROVIDING AFFORDABLE CHILDCARE THAT NURTURES YOUNG MINDS AND FOSTERS THEIR DEVELOPMENT.

RATES

Updates in Progress.

RULES

UPDATES IN PROGRESS.

RELATIONSHIPS

UPDATES IN PROGRESS.

Childcare Enrollment Form

[Your Name] Home-Based Childcare Enrollment Form

Child Information:

Child's Full Name:
Date of Birth:
Gender:
Child's Health Concerns/Allergies:
Child's Medications (if any):

Parent/Guardian Information:

Parent/Guardian Name:
Address:
City:
State:
Zip Code:
Phone Number:
Email:

Emergency Contact Information:

Emergency Contact Name:
Relationship to Child:
Phone Number:

Child's Medical Information:

Name of Child's Primary Care Physician:
Physician's Phone Number:
Health Insurance Provider:
Policy Number:

Authorized Pick-Up Persons:

1. Name:
Relationship to Child:
Phone Number:
2. Name:
Relationship to Child:
Phone Number:

Childcare Schedule:

Start Date:
Days of the Week:
Hours of Care:

Fees and Payment:

Please specify the agreed-upon fees and payment schedule for childcare services:

Acknowledgment and Consent:

I, the undersigned, acknowledge that I have received and read the childcare provider's policies and procedures.
I understand and agree to abide by the terms and conditions set forth in this enrollment form.
Parent/Guardian's Signature:
Date:

Media Release (optional):

I give permission for my child's photograph to be taken and used for promotional materials related to the childcare program.
Parent/Guardian's Signature (if applicable):
Date:

Childcare Provider's Information:

Provider's Name:
Address:
City:
State: AL
Zip Code: Madison County
Phone Number:
Email:

Services