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Jl Cempaka Wangi No 22, Jakarta

Opening Hours

Mon - Fri : 09.00 AM - 03.00 PM

Child Pre-registration Form

Tiny Lanterns Childcare

Instructions: Please complete this form with accurate information about your child. All fields are required unless otherwise stated.
1. CHILD’S INFORMATION
2. PARENT/GUARDIAN INFORMATIONLIFICATIONS
� Primary Parent/Guardian
� Secondary Parent/Guardian (if applicable)
3. EMERGENCY CONTACTS (OTHER THAN PARENTS)
1st Emergency Contact
2nd Emergency Contact
4. MEDICAL INFORMATION
5. CHILD’S ROUTINE & PREFERENCES
6. AUTHORIZATIONS
7. PARENT/GUARDIAN SIGNATURE
I confirm that the information provided is accurate and up to date.
� Please submit this form along with any required documents (immunization records, medical notes, etc.) at the moment of the formal registration.
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