Admissions Order Number Child's Information First Name * Last Name * Date of Birth * Nickname Gender Male Female Selection * Day CarePreschool Address * Health Review List any existing known medical conditions, medication and/or any matter requiring special attention for your child. Allergies If my child has trouble falling asleep I usually My child is afraid of Anything else you would like to share about your child to help him/her feel more comfortable (especially in the first week, when there is unfamiliarity in the relationship) Pediatrician's Name Pediatrician's Phone Pediatrician's Address Parents/Guardian(s) InformationParent/Guardian First Name Last Name Address Home Phone Cell Phone Occupation Employed By Office Address Office Phone Working Hours CNIC Email Address Preferred PIN for Checking In/Out (4 digits, numbers only) 1st Option 2nd Option
