For School Year
Enrollment
New Enrollment
RE - Enrollment
Child's Name
Child's Birth Date
Sex
Male
Female
Address
City
State
Postal code
Phone
Parent/Guardian 1 Details:
Parent/Guardian 1 First Name
*
Parent/Guardian 1 Last Name
*
Please check if address is same as above
Yes
Parent/Guardian 1 Street Address
Parent/Guardian 1 City, State, Zip
Parent/Guardian 1 Email
Parent/Guardian 1 Home Phone
Parent/Guardian 1 Cell Phone
Parent/Guardian 1 Work Phone
Parent/Guardian 1 Employer
Employer Address
Parent/Guardian 2 Details:
Parent/Guardian Name 2
Please check if address is same as above
Yes
Parent/Guardian 2 Street Address
Parent/Guardian 2 City, State, Zip
Parent/Guardian 2 Email
Parent/Guardian 2 Home Phone
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Work Phone
Parent/Guardian 2 Employer
Employer Address
Other Children in Family:
Child's Name 1
Child's Age 1
Child's School 1
Child's Name 2
Child's Age 2
Child's School 2
School Previously Attended
School Currently Attending
How did you hear about us?
Before/After Care Needs:
7:30 - 8:20 AM
3:15 - 5:30 PM
Are there special problems- health, transportation etc. of which we should be aware?
Signature of Parent/Guardian
Clear
Date
Enrollment Commitment
Signature of Parent/Guardian
Clear
Date
Signature of Parent/Guardian
Clear
Date
Photo Permission
Signature of Parent/Guardian
Clear
Date
Field Trip Permission
Name of Child
Signature of Parent/Guardian
Clear
Date
Submit