Child Care Form

Child Care Sign-Up

*First Name:
*Last Name:
Address:
City:
State:
Phone:
*Email:
Best time to contact you:
(ex: 8:00pm)
How many children need care?:
Provide the age for each child:
(ex: 1st child= 4yrs old, 2nd child= 3yrs old, etc.)
Provide the number of hours each child will need care:
(ex: 1st child= 3hrs, 2nd child= 5yrs, etc.)
Provide the date care is needed for each child:
(ex: 1st child= 2/1/10, 2nd child= 3/3/10, etc.)
Comments:

Mission Avenue Preschool

Open Mon-Fri: 6am-6pm
2433 Mission Avenue
Carmichael, CA 95608
916-487-4647
missionpreschool@sbcglobal.net

Children Come First Policy

*Caring, State-Certified Teachers
*Low Student-to-Teacher Ratio
*Full Academic Programs
(Educational Field Trips Included)
*Large, Fully Equipped Play Areas
*Nutritional Snacks and Hot Lunches
*Special Summer Activities
*Ages 6 Weeks to 12 Years
*Competitive Prices

In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (800)-795-3272 or (202)-720-6382 (TTY). USDA is an equal opportunity provider and employer.