Enrollment Application

Wyczyść formularz

Session*When will you be starting care?

Infant ProgramFor children 6 weeks - 18 months old

Toddler ProgramFor children 18 months - 3 years old

Children's House (Morning Options)For children 3-6 years old

Children's HouseFor children 3-6 years old

Youth ProgramFor children Kindergarten-6th grade for before and after school care, summer camp, and overnights

Other ShiftsIf you selected "other, please specify," please elaborate on the shift desired.

Child

child_name

Birthday

Child's Gender

Parent 1 / Guardian

Parent's Name

Parent's Address

Home Number

Mobile Number

Work Number

Parent 1 Email

Parent 2 / Guardian

Parent 2

Parent 2 address

Home Number

Mobile Number

Work Number

Parent 2 email

Background information

Siblings

How did you hear about us?

Previous childcaresPlease list every school that your child has attended

Educational GoalsWhat are your educational goals for your child? How do you see us facilitating these goals?

Parental InvolvementWhat role can we expect the child's parent(s)/guardian(s) to play in facilitating this child's educational goals?

Hobbies \ InterestsDoes your child have any hobbies, sports, or special interests, capabilities or talents?

Social Emotional developmentHow do you see your child in their social and emotional development?

Educational ExperiencePlease describe your child's educational experience thus far. What has been successful? What has been challenging?

Remedial Work and TutoringHas your child had any remedial work, special tutoring, or enlightenment classes in the past two years? Please explain.

Special NeedsDoes 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.

Special Help and EncouragementAre there any areas in which we may be able to give special help and encouragement to your child?

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.