Enrollment Application

We’re excited you are considering Circle of Love Daycare for your childcare needs. Please complete this enrollment application so we can get to know about your child and their needs. We’ll get back to you about any available spots and set up an interview and tour! If you have more than one child needing care, you will need to complete an additional application.

Note: We don’t accept DHS payments for childcare services.

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Child's name*

Child's birthday*

MM slash DD slash YYYY

What days do you need childcare?*

Monday

Tuesday

Wednesday

Thursday

Friday

Desired start date of care*

MM slash DD slash YYYY

What time frame do you need childcare? (Ex. 8am-4pm)*

Are you looking for long term or short term care?*

long term

short term

Has your child been in childcare before?*

Yes

If yes, what was the reason for enrollment termination or withdrawal?

Tell us about your child's personality:*

What are your child's interests?*

Does your child have any behavioral issues that are of concern?*

Does your child have any special dietary needs?*

Does your child have special needs or health conditions?*

Does your child have any allergies? If yes, please list all known.*

Is your child up to date on all vaccinations?

Yes

Other

Anything else you feel we should know, or any special needs required to care for your child?*

How did you hear about us?*

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Comments

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CONTACT INFORMATION

Circle of Love Daycare, LLC
33611 Hazelwood Street
Westland, MI 48186

Phone: (734) 652-5914

Hours: 7:00 aM - 4:15 pM

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Resources

Potty Training (Mayo Clinic)
3-Day Potty Training
Consumer Product Safety Commission
Health & Human Services (MDHHS)
Child Abuse & Neglect

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CONTACT INFORMATION

Phone: (734) 652-5914

Hours: 7:00 aM - 4:15 pM

Links

Resources