Child Care Agreement

Please complete this Child Care Agreement form before your child beginds learning and care at A Child's Heart. We try to make the application process as painless as possible. You will complete this one form, which encompasses a total of four essential documents (Intake, Medical History, Immunization, and Consent) during the application process. This form allows us to have a general knowledge of your child's background, an in-depth overview of your child(ren)'s medical history (so we can provide your child with the proper care), allows us to provide care to your child in the case of a medical emergency, and informs us of the of the times and days your child(ren) will attend A Child's Heart.  For your convenience, we offer two ways you can complete this form-- either electronically or by downloading the PDF and printing it out.  

By completing the form below, A Child's Heart will be able to provide the best possible care and learning environment for your child. 

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Child Care Agreement Form


If you have any questions, please feel free to Contact Us!


Childcare Agreement Form

*Note: All fields marked with an asterisk (*) are required.