Enrollment

Start Your Child's Journey Today

Spots are filling fast. Contact us today to learn more about enrollment and schedule a tour.

Submit Application

Fill out the enrollment form with your child's information.

We Reach Out

Our team contacts you within 1 business day to discuss next steps.

Tour & Welcome

Visit our center, meet the team, and welcome your child to Genesis.

Apply Now

Enrollment Application

Tell us about your child and we'll be in touch to walk you through enrollment.

No application fee to get started
Flexible full-time & part-time schedules
Sibling discounts available
Financial assistance options

Child Information

Child's Full Name *

Date of Birth *

Age

Gender

Primary Language Spoken at Home

Home Address *

City

State

Zip Code

Requested Start Date

Program Interested In *

If Other, please describe

Parent / Guardian Information

Parent / Guardian 1

Full Name *

Relationship to Child *

Phone Number *

Email Address *

Home Address

If different, address

Employer

Work Phone

Parent / Guardian 2 (optional)

Full Name

Relationship to Child

Phone Number

Email Address

Home Address

If different, address

Employer

Work Phone

Emergency Contact Information

Please list at least two people who may be contacted if parents/guardians cannot be reached.

Emergency Contact 1

Full Name *

Relationship to Child *

Phone Number *

Address

Emergency Contact 2

Full Name *

Relationship to Child *

Phone Number *

Address

Authorized Pickup List

The following people are authorized to pick up your child from Genesis Steps to Success.

Name

Relationship

Phone Number

Name

Relationship

Phone Number

Name

Relationship

Phone Number

People NOT authorized to pick up the child

Health & Medical Information

Child's Doctor / Pediatrician

Doctor's Phone Number

Health Insurance Provider

Policy / Member ID

Does your child have any allergies?

If yes, please explain

Does your child take any medication?

If yes, medication and instructions

Medical conditions, special needs, or dietary restrictions?

If yes, please explain

Child Development & Daily Routine

Previous daycare or preschool experience?

If yes, where?

Is your child potty trained?

Does your child nap during the day?

Typical nap time

Favorite activities or interests

Things that comfort your child

Any fears, behavior concerns, or important notes we should know?

Meal & Snack Information

Can your child eat meals/snacks provided by the program?

Food allergies or restrictions

Foods your child should avoid

Permissions

Please check each box to give permission.

I give permission for my child to participate in indoor and outdoor activities.

I give permission for my child to participate in arts, crafts, music, movement, and learning activities.

I give permission for Genesis Steps to Success staff to apply basic first aid if needed.

I give permission for Genesis Steps to Success to contact emergency services if necessary.

I give permission for my child's photo/video to be used for classroom updates or parent communication.

Optional: I give permission for my child's photo/video to be used for marketing/social media.

I understand that I must notify Genesis Steps to Success of any changes to emergency contacts, pickup authorization, allergies, or medical information.

Parent Communication Preference

Preferred method of communication

Best time to contact parent/guardian

Enrollment Agreement

I understand that enrollment is not complete until all required forms, emergency contact information, health information, and payment arrangements have been submitted and approved.

I agree to follow Genesis Steps to Success policies regarding attendance, pickup, illness, payments, communication, and child safety.

I have read and agree to the enrollment agreement above.

Parent / Guardian Name (signature) *

Date *