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When will you be starting care?
☐ 2021-22
☐ 2022 Summer
☐ 2022-23
For children 6 weeks - 18 months old
☐ Full Day (1st Shift)
☐ Full Day (2nd Shift)
☐ Other, please specify
For children 18 months - 3 years old
☐ Full Day (1st Shift)
☐ Full Day (2nd Shift)
☐ Full Day (3rd Shift)
☐ Other, please specify
For children 3-6 years old
☐ Children's House: Morning Program (8:30a-12:30p)
☐ Children's House: Full Day Program (8:30a-2:45p)
For children 3-6 years old
☐ Full Day (1st Shift)
☐ Full Day (2nd Shift)
☐ Full Day (3rd Shift)
☐ Other - please specify
For children Kindergarten-6th grade for before and after school care, summer camp, and overnights
If you selected "other, please specify," please elaborate on the shift desired.

Child

☐ M
☐ F

Parent 1 / Guardian

Parent 2 / Guardian

Background information

Please list every school that your child has attended
What are your educational goals for your child? How do you see us facilitating these goals?
What role can we expect the child's parent(s)/guardian(s) to play in facilitating this child's educational goals?
Does your child have any hobbies, sports, or special interests, capabilities or talents?
How do you see your child in their social and emotional development?
Please describe your child's educational experience thus far. What has been successful? What has been challenging?
Has your child had any remedial work, special tutoring, or enlightenment classes in the past two years? Please explain.
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.
Are 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.