Clear Form
☐ Spring 2021
☐ 2021-22
☐ Fall 2022
☐ Lower Elementary (1st through 3rd Grade)
☐ Upper Elementary (4th through 6th Grade)
☐ Aftercare from 3 to 6 pm Everyday
☐ Drop-In Aftercare
☐ No Aftercare Needed
☐ Unknown at This Time


☐ M
☐ F

Parent / Guardian 1

Parent / Guardian 2

Background information

Please list all household members and their relationship to your child. Please share ages and schools of siblings.
Please let us know about parents'/guardians' relationship (married, divorced, remarried, deceased parent, etc. This helps us to understand your child's family structure.
☐ English
☐ Spanish
☐ French
☐ German
☐ Chinese
☐ Other:
Please list every school that your child has attended, including years of attendance.
Please describe your child's educational experience thus far. What has been successful? What has been challenging?
What are your educational goals for your child? How do you see us facilitating these goals?
Does your child have any hobbies, sports, or special interests, capabilities or talents?
Please describe your child's current reading skills and share the titles of 3 books that your child can read independently.
Please describe your child's writing skills. Does your child write in print and/or cursive? Describe what your child is your currently writing (reports, short stories, lists, labels, etc.)
Please describe your child's current math work.
Does your child have any special needs (educational, medical, or psychological)? Has your child received any testing or evaluations that would relate to their academic or social performance? Please have copies sent of tests or evaluations that your child has taken.
Please list your child's allergies, if any.
Please list any medications that your child takes on a regular basis.
Are there any areas in which we may be able to give special help and encouragement to your child?
Anything else you would like to share with us?

Non-Discrimination Policy

We value diversity among our students. We do not discriminate in our enrollment policies on the basis of race, color, gender, religion, sexual orientation, national or ethnic origin.