Victory Assembly of God - IN - Victory Kids Child Care

Bright Beginnings Childcare and Preschool
Enrollment Form

Victory Kids Child Care is an Unlicensed Registered Child Care. It is a ministry of Victory Assembly of God.
We are now taking enrollments.

Child #1 - First Name

Child # 1 - Last Name

Child #1 - Date of Birth

Child # 2 - First Name

Child # 2 - Last Name

Child # 2 - Date of Birth

Child's Address

Address 2

Apartment Number

City

State

Zip/Postal Code

Do you have another child or children enrolled at our center?
No
Yes

If yes, please give child's name.

Desire Date to Start
ASAP
Fall of 2023
Winter of 2023

Parent / Guardian's # 1 First Name

Parent / Guardian's # 1 Last Name

Relationship to the Child
Father
Mother
Guardian
Foster Parent

Phone Number

Email

Parent / Guardian # 2 First Name

Parent / Guardian # 2 Last Name

Relationship to the Child
Father
Mother
Guardian
Foster Parent

Phone Number

Email Address

If referred, name of the person who referred you:

How Did You Hear About Us?

What Services Are You Looking For First Child?
Child Care for Infants 6 Weeks to 1 Year Old
Child Care for 1 - 2 Year Old
Preschool - 3 - 4 Year Old

What Services Are You Looking the Second Child?
Child Care for Infants 6 Weeks to 1 Year Old
Child Care for 1-2 Year Old
Preschool - 3-4 Year Old

Anything else you would like to tell us about your family?

Child Care / Preschool Fees:
Registration: $180
$180 - Infants 6 Weeks Old to 4 Years of Age
Multi - Child Discount