A completed registration form is required on the first visit to Irvine Super Fun learning center. The information provided on this form with contact details is important for families and the center. The form will cover child's medical information such as age any allergies or special requirements. On subsequent visit all parents/guardians are required to sign the registration form upon arrival and again at the time of pick up. The same parent/guardian who brings the child to the center must pick up the child unless prior arrangments have been made at the time of the initial registration or at the time of specific drop off. When checking out you will receive a summary of the stay that will include any additional charges incurred. All charges incurred are due and payable at checkout time. if a member's program hours have been exceeded, the additional charges will be due at the time of checkout and will be billed at the then drop-in rate. We will accept cash, checks, MasterCard, and visa.

 

To expedite your child's registration process, please fill out the application below and print it prior to
your first visit and bring it to our center.

You can also download a blank form and complete it by hand.

Child's Name
Last		Middle		First		Date of birth			Sex
						January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 14 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995			MF
						January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 14 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995			MF
						January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 14 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995			MF
						January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 14 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995			MF
Parent's name(s):                    Last name:						First name:
Phone      Home:				Work:			Cell:
Driver's license:				E-mail Address:
Address:							Apt.:
City:				State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming		zip:
Parent's name(s):                    Last name:						First name:
Phone      Home:				Work:			Cell:
Driver's license:				E-mail Address:
Address:							Apt.:
City:				State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming		zip:
Emergency Contact Last name:						First name:
Phone      Home:				Work:			Cell:
Address:							Apt.:
City:				State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming		zip:
Persons authorized for pick-up:
Emergency Physician and Dentist Information:
Physician's Name:				Phone#:			Medical plan#
Address:
Dentist's Name:				Phone#:			Medical plan#
Address:
Are your child's immunization up to date?							Yes   No  (circle one)
Does your child have any special needs, medical concerns, or allergies?
Does your child have any likes, dislikes or special requests?