Child Care Registration

Registration
Kids Of Valor Academy - 12775 Medfield Drive unit B, -Houston, Texas 77082
832-406-7477
Select Program:

Before & After CarePreschool 2Preschool 3Preschool 4Toddler
Child's Information
First name
Last name
M.I.
Street address
Street address line 2
City
State
Zip code
Male or female?

FemaleMale
Hours of child care required (school hours are 7:00 am to 6:00 pm)

Full dayHalf-day morningHalf-day afternoonOther
Days of the week required

MondayTuesdayWednesdayThursdayFriday
Do you require before or after school care?

Before schoolAfter school
Parent's Information
Parent's/Guardian's name
Phone number
Place of work
Email address
Emergency Contact 1
In the event of an emergency, please contact:
First name
Last name
Primary phone number
Secondary phone number
Emergency Contact 2
In the event of an emergency, please contact:
First name
Last name
Primary phone number
Secondary phone number
Other people authorized to pick up your child from school
First name
Last name
First name
Last name
Medical information
Doctor
Doctor's phone number
Dentist
Dentist's phone number
Preferred hospital
Insurance/health coverage
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns.
Should be Empty: