Enrollment Application

Enrollment Application
Child's Name*
First Middle Last
Gender*
- Male
- Female
Age*
Date of Birth*
Date Format: MM slash DD slash YYYY
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone #*
Program Schedule
Please choose the program:*
- Preschool Program (ages 2 – 4 years)
- Kindergarten Program (ages 5 – 6 years)
Please choose program schedule:*
- 2 days morning classes (8:45am – 11:45am)
- 3 days morning classes (8:45am – 11:45am)
- 5 days morning classes (8:45am – 11:45am)
- 2 days afternoon classes (3pm – 6pm)
- 3 days afternoon classes (3pm – 6pm)
- 5 days afternoon classes (3pm – 6pm)
- 2 days full day program (9am – 3pm)
- 3 days full day program (9am – 3pm)
- 5 days full day program (9am – 3pm)
- 2 days extended day program (7am – 6pm)
- 3 days extended day program (7am – 6pm)
- 5 days extended day program (7am – 6pm)
Check the days:*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
My child will arrive at school at:
My child will be picked up from school at:
Parent/Guardian #1
Parent/Guardian’s Name*
First Last
Relationship*
Cell Phone*
Email Address*
Work Phone
Occupation*
Employer*
Parent/Guardian #2
Parent/Guardian’s Name
First Last
Relationship
Cell Phone
Email Address
Work Phone
Occupation
Employer
Emergency Contact*
Name Address Phone Relationship

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Signature*
Date*
Date Format: MM slash DD slash YYYY

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Name	Address	Phone	Relationship