Parkmead Keyspot Daycare Program

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Returning Family Registration 2011-2012

Thank you for choosing Parkmead Keyspot for your childcare needs. We know that you can choose any place for your child to be and we feel honored that you have chosen to return to Keyspot. In efforts to make the registration process easier for you, Keyspot has provided you the opportunity to fill out and return your Registration for the 2010-11 school year online. Just fill out the form provided to your right and send it us. It's that quick and that simple. Thank you again for choosing Parkmead Keyspot for yet another year. It is a pleasure serving you and your family.

Click Here for Printable Registraion Form
Returning Family
Registration Fee Schedule 11-12

Returning Family Reg Fee - $100/family

Please send your Reg Fee to:
Parkmead Keyspot
1920 Magnolia Way
Walnut Creek, CA 94595
(checks payable to PARKMEAD KEYSPOT)
OR
Drop it off in the "Black Box" on the Parent Desk inside the Keyspot room.
REGISTER ON OR BEFORE JUNE 10, 2011 AND
TAKE 50% OFF YOUR REG FEE
!
Returning Family Registration 2011-2012

Fill in the form completely. Then drop off or mail a check to us for your registration fees. Reg fee for a returning family is $100.00
Child's Last Name
Child's First Name
Child's Date of Birth
Child's 2010-2011 Grade
Please list any Allergies
Mother's First and Last Name
Mother's Address
Mother's Home Phone #() -
Mother's Work #() -
Mother's Cell Phone #() -
Mother's Email Address
Father's First and Last Name
Father's Address
Father's Home Phone #() -
Father's Work Phone #() -
Father's Cell Phone #() -
Father's Email Address
Who has physical custody of this child?
Child's Physician Last Name
Physician's Phone #() -
Does this child have Health Insurance?
Health Insurance Company Name
Policy #
John Muir or Kaiser in case of emergencies?
Dentist Last Name
Dentist Phone #() -
#1 - Emergency Contact Name
#1 - Emergency Contact Phone #() -
#2 - Emergency Contact Name
#2 - Emergency Contact Phone #() -
Authorized Pick Up Person #1
Pick Up Person #1 Phone #() -
Authorized Pick Up Person #2
Pick Up Person #2 Phone #() -
Authorized Pick Up Person #3
Pick Up Person #3 Phone #() -
Comments or Special Instructions
PARKMEAD KEYSPOT DAYCARE PROGRAM - 1920 MAGNOLIA WAY, WALNUT CREEK CA 94595 - OFFICE (925) 9391543 - FAX (925) 939-5942