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APPLICATION FOR ENROLLMENT
NAME OF
CHILD…………………....................................………………….DOB……/……/…….............
ADDRESS……………………….........................……………….CITY….............…………………………..
STATE…….....................………ZIP
CODE…......…………………PHONE…...……........……………….
MOTHER…………………….......………………OCCUPATION………................................……………...
FATHER…………………………….......……….OCCUPATION……...................…................………......
DAYTIME
PHONE…………....................….... EMERGENCY CONTACT……...……..............………...
CELL PHONE…………….................………
E-MAIL……...................................................................
PRIOR EARLY
CHILDHOOD PROGRAM ATTENDED:……......................................…………………..
DATES…………………….........…...................................................................................................
MEDICAL RESTRICTIONS
OR
LIMITATIONS…….....................................……………………………..
FOOD CONSIDERATIONS
OR
ALLERGIES……….....................................…………………………….
REFERRAL TO THE
CREATIONS PROGRAM………….....................................……………………….
PLEASE PROVIDE A BRIEF DESCRIPTION OF YOUR CHILD,
INCLUDING STRENGTHS, WEAKNESSES, LIKES AND DISLIKES;
FACTORS THAT WILL HELP THE TEACHER PROVIDE THE BEST
OPPORTUNITY TO KNOW AND TEACH YOUR CHILD.
…………………………………………………………….........................…………………………….
…………………………………………………………………….........................…………………….
………………………………………………………………….........................……………………….
NON-REFUNDABLE $100.00 DEPOSIT
REQUIRED UPON REGISTRATION – APPLIED TO TUITION PAYMENT.
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