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Wednesday, February 22, 2012
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ENROLLMENT APPLICATION
Date
Grade*
<Select>
Infants
Pre-K1
Pre-K2
Pre-K3
Pre-K4
Kindergarten
Before/After School
School Break
Student's Name*
Student's Name (2)
Student's Name (3)
Student's Name (4)
Student's D.O.B.*
Student's Age*
Student's Gender*
Female
Male
Student's Ethnicity
2nd Student's D.O.B.
2nd Student's Age
2nd Student's Gender
Female
Male
2nd Student's Ethnicity
Parent/Guardian Information
Student(s) Lives with
Both Parents
Mother
Father
Legal Guardian
Foster Parents
Student's Legal Guardian(s)
Both Parents
Mother
Father
Foster Parents
Other
Student's Primary Address*
City*
State*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code*
Phone Number*
Mom's First Name*
Mom's Last Name*
Mom's Address
Mobile Number
Occupation
Employer
Work Phone
Father's Name*
Father's Last Name*
Father's Address
Mobile Number
Occupation
Employer
Work Phone
Guardian's First Name
Guardian's Last Name
Address
Mobile Phone
Occupation
Employer
Work Phone
Student's Personal Information
My child has the following needs:
The following special accommodation(s) may be required to mosteffectively meet my child's needs while at this center...
My child is currently on medication(s) prescribed for long-term conditionous use and/or has the following pre-existing illness, allergies, or health concerns...
Student's Physician/Clinic's Name*
Address
Phone Number*
Person(s) to contact in case of an emergency when parents cannont be reached:
(1) Name*
Address
Phone Number*
Relationship
(2) Name*
Address
Phone Number*
Relationship
The student may be released to the person(s) signing this agreement or to the following:
(1) Name
Address
Phone Number
Relationship
(2) Name
Address
Phone Number
Relationship
Submit
* Required
Download Application
If you would like to print the enrollment application, please click here.
Schedule a Tour
First Name*
Last Name*
Contact Number*
Email Address
Tour Date
Tour Time
Submit
* Required
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