Registration Form

You may fill out the form below and someone will get back with you to complete the registration process. Alternatively you may simply download the Registration Form from HERE, fill it out, sign and fax to:

1 (703) 502-0589.

Please note that Sparkles! Child Care is compliant with Section 63.2-1809 of the Code of Virginia.

Location

* Location:

Child Registration

* First Name:

* Last Name:

* Nickname:

* Date of Birth:

* Sex:

* Address:

* Home Phone:

Chronic Physical Problems/Pertinent Development Information/Special Accommodations Needed:

Previous Child Day Care Programs and Schools Attended:

Parent(s)/Guardian(s)

Father

* Father Name:

* Place Employed:

* Business Phone:

* Home Address:

* Home Phone:

* OK to Send Information via Email:

* Primary Email:

Secondary Email:

* City:

* State:

* Zip Code:

* Cell Phone:

Mother

* Mother Name:

* Place Employed:

* Business Phone:

* Home Address:

* Home Phone:

* OK to Send Information via Email:

* Primary Email:

Secondary Email:

* City:

* State:

* Zip Code:

* Cell Phone:

Legal Guardian

* Person(s) or Agency Having Legal Custody of Child:

* Home Address:

* Home Phone:

* Business Address:

* Business Phone:

Emergency Information

Allergies or Intolerance to Food, Medication, etc., and Action to Take in an Emergency:

* Child's Physician:

* Child's Physician's Phone:

* Person(s) Authorized To Pick Up Child:

* Person(s) NOT Authorized To Pick Up Child:

Person 1

* Name:

* Address:

* Phone:

Person 2

* Name:

* Address:

* Phone:

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Actions

Enrollment

Registration Form

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Extended Hours

AVAILABLE AT

Fair Oaks And Chantilly

6:00am - 8:30pm

Locations

Sparkles! at Crystal City
Now Enrolling

1235 S Clark Street, Gateway One
Arlington, VA 22202
V: 571-312-1052
F: 571-970-0825
Email: Crystalcity@sparklesontheweb.com

Sparkles! at Chantilly

4229 Lafayette Center Drive
Suite 1600
Chantilly, VA 20151
V: 703-955-7202
F: 703-955-7273
Email: Tabitha@sparklesontheweb.com

Sparkles! at FairOaks
Fairfax

12001 Lee Highway
Fairfax, VA 22030
V: 703-502-8100
F:703-502-0589
Email: fairoaks@sparklesontheweb.com

Sparkles! at White Oaks ES
Extended Day Program

6130 Shiplett Blvd.
Burke, VA 22015
V: 703-501-1709
F:703-502-0589
Email: brittany@sparklesontheweb.com