Pre Enrollment Pre-Enrollment Questionnaire Pre-Enrollment Form Full Name of Child 1: Full Name Full Name of Child 2: (if applicable) Full Name Children's Date of Birth: * First Child DOB/ Second Child DOB Parent Full Name: * Parent or Guardian full name Email: * Phone: * Physical Address: Choice of Location: * Mandeville Center Prairieville Center Zachary Center Main Street Center, Baton Rouge OLOL Center, (Picardy Avenue) Baton Rouge Woman's Center Crestworth Elementary (PK-3) Rouzan Center, Baton Rouge, COMING 2021 Family Referral: No if yes, whom: Expected start date: Days of Care Requested: Monday Tuesday Wednesday Thursday Friday Hours of Care Requested: What age group are you interested in: 6wk - 1 yr Ages 2 - 4 yrs Ages 5 - 7 yrs Ages 8 - 10 yrs Ages 11 - 15 yrs What is most import to you when choosing a child care center for your child/children? * What is your current childcare situation & why are you looking for a new child care arrangements? * Any concerns or special needs of parent? Any other questions or comments? Where did you hear about Kidz Karousel? Online Search Newspaper Magazine Friend/Family EBR Early Childhood Community Network If you are human, leave this field blank. Submit
