Child Intake Form — Paradise Childcare

Let’s work together!

Interested in allowing PCC to be a part of your child’s care? Fill out the form below and we’ll be in touch!

Name

First Name

Last Name

Email

Phone

(###)

###

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What age(s) is/are your child(ren)?

Select all that apply

Infant

Toddler

Child - School Age

Tell us a little about your kids:

Name, age, etc.

How did you hear about us?

Other: