Registration

Enroll your child at Bright Stars Children’s Center. Simply fill out the form below and we will contact you for the enrollment process.

Child's Information

Child's Full Name:

Birth Date:

Age:

Sex:

Parent/Guardian's Information

Parent/Guardian's Name:

Address:

City:

State:

Email:

Phone:

Person to Contact in Case of Emergency if Parent/Guardian Cannot be Reached

Name:

Address:

Health Information

Name of Child's Doctor:

Phone:

Hospital Preference:

Please list down any allergies or dietary restrictions of the child:

Additional Information