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If you would like to apply for Basics of Life Christian Child Care or Preschool,
please print out the application below and contact us.

You can call us and then fax it to (740) 694-1622  or mail it to:

Basics of Life Christian Child Care
17030 Old Mansfield Road
Fredericktown, OH 43019




Basics of Life Christian Child Care is a Christian based child care and pre-school for children of all ages who seek opportunities to learn and grow. 
Our goal is to help every child to be happy and secure and to develop his or her true potential. To meet this goal we offer families safe, nurturing,
educational childcare opportunities that reflect their values and concerns. We provide an experience through caring relationships and a nurturing
spiritual and social environment. We work to develop relationships that build trust and confidence. 

Please provide the following contact information:


Parent Name(s) _______________________________________________________

Address _____________________________________________________________

City __________________________________State __________ Zip ____________

Email address  _______________________________________________________


Telephone numbers (include area code) where you can be reached:



Hours you can be reached at this number




Mom - Work



Dad - Work



Mom - Cell



Dad - Cell



Other _________




In case of an emergency, and you can not be reached, please provide an additional contact


name and phone number _____________________________________________________



What type of care are you interested in?

Full Time                    Part time                   Preschool only

What days of the week do you require care?

 Monday            Tuesday            Wednesday                Thursday           Friday



What times do you require care?       Drop off time: _______________  AM / PM
Pick up time: ________________  AM / PM


What date would you like to start? ____________________________________


Please provide the following information about the child requiring care:


First and Last Name: _________________________________

Gender         Male        Female       

Birth Date ______________________



Does your child have allergies or other special needs we need to be aware of?


Allergies. __________________________________________________________________



Special Needs:




Is your child potty trained?                Yes          No


Do you have any other concerns you feel need to be addressed? ____________________________________________


How did you hear about Basic of Life Christian Child Care? ___________________________________



Basics of Life Christian Child Care admits children without regard to race, color, national origin, ancestry,
gender, disability or socioeconomic status.  It does not discriminate on any of the above factors in administration
of its educational policies, admissions policies, or other administered programs. 




PLEASE SEND COMPLETED APPLICATION TO:     Basics of Life Christian Child Care
                                                                         17030 Old Mansfield Road
                                                                         Fredericktown, OH  43019

The information collected on this form will only be used to promote your child enrollment and care with Basics of Life Christian Child Care.

Copyright 2004 Basics of Life Christian Child Care. All rights reserved.


17030 Old Mansfield Road, Fredericktown, OH 43019 - 740-694-1622