Milford Enrollment Form

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Parent/Guardian Contact Info - Milford Enrollment Only

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First Name

Last Name

Address

Apt, Suite, Bldg. (optional)

City

State

Zip Code

Phone

Email

Child Information

First Name

Last Name

Date of Birth (mm/dd/yyyy)

First Name

Last Name

Date of Birth (mm/dd/yyyy)

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Schedule Information

Days Needed

Monday

Tuesday

Wednesday

Thursday

Friday

check all that apply

Start Time

Drop child off

End Time

Pick up child

Scheduling Comments, Other Comments

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Duck Pond Day Care - Hamden
84 Washington Avenue
Hamden, CT 06518
Phone: (203) 281-3825

Duck Pond Day Care - Milford
132 New Haven Avenue
Milford, CT 06460
Phone: (203) 878-9876