New Family and Student Registration Form

We do annual fundraising to support our mission of increasing quality early care and education in the entire Spokane area as well as to support the Community Building Children's Center.

Would you or your employer be interested in supporting a fundraising event with a donation or sponsorship?

Is there a second parent or guardian?

Would you or your employer be interested in supporting a fundraising event with a donation or sponsorship?

Who will be bringing and picking up the child(ren) to and from the center each day? Please include yourself and list individuals in order of frequency. You may add up to five individuals, just click on the plus sign at the end of each row to add another row.

Please let us know what time your child(ren) will be dropped off each day. We prefer that it is no later than 9:30 (we open at 7:30).

Please let us know what time your child(ren) will be picked up each day. We prefer that it is no earlier than 3:15. (We close at 5:30. There is a fee of $1/minute for every minute after 5:30 that the child(ren) are not picked up.)

Please list up to five individuals, just click on the plus sign at the end of each row to add another row.

We are enrolled in Working Connections. Please bill DSHS accordingly for our tuition costs.

Which address should we use for billing? Monthly invoices and receipts are sent by email.

Please describe your family, including significant people that your child relates to:

What beliefs, traditions, or holidays are important to your family? What would you like us to know about them? Would you like to share them with the program? If so, how would you like to do that?

Please tell us about any of your child(ren)'s fears or dislikes that you would like us to know about:

What is the best way to comfort your child(ren) if he/she is upset?

Please upload one or more photos of your family, pets, and close extended family to put in your child's portfolio. We use these photos with your child to help calm and reassure them when they are missing you.

Has this child been in group care before?

Does this child take naps?

Is this child toilet trained?

Please indicate what health exams your child has had:

Create an account on MyIR.net to access your child’s immunization records. This takes about five minutes to complete. Once you have created your account, please download and/or print out the immunization record for each child enrolled in our program and upload the file here.

For allergies of a serious nature that cause reactions involving hives or other potentially severe symptoms requiring the administration of medication or emergency medical response, a full Allergy Reaction Plan & Medication Orders are required from your health care provider.

Are any of the above life threatening?

Please list any illnesses (common to chronic) and serious accidents that you child has had and at what age. You can add rows by clicking on the plus sign at the end of each row.

How does your child act when ill? (Cries, sleeps a lot, pulls on ears, etc.)

Does your child have frequent colds?

Tell us more about the type of colds and frequency.

Please describe any other health concerns that our staff should be aware of:

Has this child been in group care before?

Does this child take naps?

Is this child toilet trained?

Please indicate what health exams your child has had:

Create an account on MyIR.net to access your child’s immunization records. This takes about five minutes to complete. Once you have created your account, please download and/or print out the immunization record for each child enrolled in our program and upload the file here.

For allergies of a serious nature that cause reactions involving hives or other potentially sever symptoms requiring the administration of medication or emergency medical response, a full Allergy Reaction Plan & Medication Orders are required from your health care provider.

Are any of the above life threatening?

Please list any illnesses (common to chronic) and serious accidents that you child has had and at what age. You can add rows by clicking on the plus sign at the end of each row.

How does your child act when ill? (Cries, sleeps a lot, pulls on ears, etc.)

Does your child have frequent colds?

Tell us more about the type of colds and frequency.

Please describe any other health concerns that our staff should be aware of: