Kid's Day Out Registration - Crossroads Preschool

What Are You Interested in Registering For?*

Please complete this registration form if you are registering your child for KID'S DAY OUT ONLY. If you are enrolling your child in BOTH Kid's Day Out and Cross Roads Preschool please Complete the Preschool Registration Form and specify that you are also registering for Kid's Day Out.

Child's Information
Child's Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Child's Gender
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Guardian's Information
Guardian Name*
First Last
Relationship to Child*
Please Specify Relationship to Child*
Guardian's Cell Phone Number*
- Text Permitted?
Guardian's Email Address*
- I agree to allow Cross Roads Preschool/Kids Day Out send me important information regarding the program.
Add Another Guardian?
- Yes
- No
Second Guardian's Name*
First Last
Relationship to Child*
Please Specify Relationship to Child*
Second Guardians Cell Phone Number*
- Text Permitted?
Second Guardian's Email Address

The infant room will be open on Monday through Friday mornings from 9 to 1, as long as there is a need.
Please indicate below the times you would like.
The classroom for the older children will open at 9 a.m. Monday through Friday. Closing time will vary according to need (not later than 3:00 p.m.). The children are limited to 4 hours a day and no more than 3 days a week, unless there is an emergency.
Please indicate below the times you would like.

Kid’s Day Out Online Registration

Step 1 of 3

Child's Information

Guardian's Information

Emergency Contacts

Additional Information

Medical Information

Permission For Medical Treatment

Waiver of Liability

Photo Release

VOLUNTEERS NEEDED!