Enrollment Form

Child Name

Grade Select Grade Kindergarten 1st Grade                             2nd Grade                             3rd Grade                             4th Grade                             5th Grade                             6th Grade                             7th Grade                             8th Grade 8th Grade                           0-2 Years                             2-6 Years - Pre K

Gender Select Gender Male Female Prefer Not to Say

Child's Date of birth

Age of the Child at the time of enrollment

Approximate Start Date

Potty training schedule from Teachers to help parents at home

Allergies

Childrens Medications

Diet restrictions

Weekend care options
YES

Mother Name

Mother Phone No.:

Mother E-mail

Father Name

Father Phone No.:

Father E-mail

Guardian Name

Guardian Phone No.:

Guardian E-mail

Anything else?