Step 1 of 6

About you

You'll get email updates about this application, and you'll e-sign the enrollment packet if a spot is offered.

Your full name Relationship to child Email

Cell phone

Home phone (optional)

Home address

Step 2 of 6

Your child

Willow Bend Learning Center serves ages 0 and up.

First name

Last name

Date of birth

Gender (optional) Preferred start date Days attending

MonTueWed ThuFri

Allergies or dietary restrictions (optional)

Shot record (optional now, required before first day) A photo or PDF of your child's immunization record.

Birth certificate (optional now) Photo or PDF — used to verify age.

Step 3 of 6

Medications

Does your child need any medication given during daycare hours? Staff can only administer what you authorize here.

No medications Yes — add medication

Step 4 of 6

Emergency & pick-up

Who can we call if we can't reach you, and who may pick your child up? You can add more later.

Emergency contact name

Relationship

Phone

Authorized pick-up person (optional)

Relationship

Phone

Step 5 of 6

Permissions & care

Texas requires these answers before your child's first day. You can change any of them later in writing.

Who may pick up your child §746.605(7)

List anyone besides you who may collect your child. If no one else is allowed, check the box instead — the state requires one or the other in writing.

No one other than me may pick up my child. I'll notify the daycare in writing if that changes.

Leaving the daycare §746.605(8)–(9)

Both need a yes or no before admission.

May we transport your child in a daycare vehicle?

May your child go on field trips away from the daycare?

Water activities §746.605(16)

Covers splash pads, wading pools and swimming.

May your child take part in water activities?

Emergency medical authorization §746.605(11)

We need an answer to both before your child can start. You can change either at any time.

If my child needs emergency medical treatment and I cannot be reached, I authorize the center to obtain it.

Yes, I authorize No

I authorize the center to have my child transported for emergency medical treatment.

Yes, I authorize No

Special care needs §746.605(12)

Leave blank if none apply. Anything you write here goes to the staff caring for your child.

Activities your child should not do (optional) Adjustments that would help (optional) Equipment your child uses, and how to use it (optional) Symptoms that mean staff should act (optional) Medication taken long term (optional)

Step 6 of 6

Review & submit

Check everything, then send your application to Willow Bend Learning Center.

Parent / guardian Edit

Child Edit

Medications Edit

Contacts Edit

Permissions & care Edit

I confirm this information is accurate. I understand this is an application — enrollment is not final until documents are signed, payment is made, and the daycare confirms a spot.

Willow Bend Learning Center is completing enrollment setup

About you

Your child

Medications

Emergency & pick-up

Permissions & care

Who may pick up your child §746.605(7)

Leaving the daycare §746.605(8)–(9)

Water activities §746.605(16)

Emergency medical authorization §746.605(11)

Special care needs §746.605(12)

School §746.605(13)–(14)

Review & submit

Parent / guardian Edit

Child Edit

Medications Edit

Contacts Edit

Permissions & care Edit