Child Care Registration

Registration

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

Select Program:

Child's Information

First name

Last name

M.I.

Street address

Street address line 2

City

State

Zip code

Male or female?

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

Other

Days of the week required

Do you require before or after school care?

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.