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Student Information

Student Name *

Birth Date *

Gender *

Female Male

Potty Trained? *

Yes No Showing Interest Not Interested

Food Allergies or Restrictions *

Yes No

Is Parental Custody Legally Restricted? Please submit appropriate legal documents with name of the parent legally restricted *

Yes No NA

Preferred start date

Mother

Full name *

Email *

Address *

Cellphone Number *

Work Phone Number *

Occupation *

Father

Full name *

Email *

Address *

Cellphone Number *

Work Phone Number *

Occupation *

Emergency Contact

At least two emergency contacts are required.

1st Emergency Contact *

1st Emergency Contact Phone Number *

2nd Emergency Contact *

2nd Emergency Contact Phone Number *

3rd Emergency Contact

3rd Emergency Contact Phone Number

4th Emergency Contact

4th Emergency Contact Phone Number

Emergency Contact Card, Immunization Records and Birth Certificate

Download the Emergency Contact Card PDF

Print it, complete it, and upload it below.

Open link

UPLOAD your completed Emergency Contact Form Here after completing

PDF or photo, up to 750 KB. Three files per registration, 900 KB total.

Upload A Copy of Your Updated Immunization Record

PDF or photo, up to 750 KB. Three files per registration, 900 KB total.

Upload A Copy of child's Birth Certificate

PDF or photo, up to 750 KB. Three files per registration, 900 KB total.

Program

Financial Policy

I have read the financial policy in its entirety and agree to comply with the terms stated herein.

Parent/Guardian Signature *

Sign above with your mouse or finger.

Photo and Filming Release

Photo and Filming Release Permission *

I agree to my Child being Filmed or Photographed Please Exclude my Child from any Filming or Photos Only Photos/Videos to be used in Procare

Parent/Guardian Signature *

Sign above with your mouse or finger.

Drop-Off & Pick-Up Policy

Please confirm each statement *

I understand this is a State regulation I will make sure that any other caregiver that is dropping-off or picking-up my child will sign them In/Out I understand that I will have to return to school within an hour if I miss a sign In/Out or I will be charged $15 If the sign In/out process doesn't go through, I will contact the Director or any staff immediately

Please confirm every item.

Parent/Guardian Signature *

Sign above with your mouse or finger.

Permission to Apply Diaper Ointment

For children under three.

Family Handbook Agreement

Click Here to Read the Bei Bei Amigos Family Handbook

Open link

Parent/Guardian Signature *

Sign above with your mouse or finger.

Registration Fee

A one-time $300 registration fee is due after you submit this form. You will be taken to a secure payment page (card or PayPal) to complete your registration.

Bei Bei Amigos Student Registration Form