Enrollment Form
Please take the time to accurately fill out the enrollment form below for each child. Once submitted for all children, please contact us to arrange the next step. NOTE: The form will not submit without all REQUIRED fields (marked with an *) completed.

"*" indicates required fields

Step 1 of 3

Child Information
Name*
Address*
MM slash DD slash YYYY
Gender*
Attendance Information
AM Attendance
This field is hidden when viewing the form
Days To Attend (AM)
This field is hidden when viewing the form
This field is hidden when viewing the form
PM Attendance
This field is hidden when viewing the form
Days To Attend (AM)
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Meals Required for PM Attendance
School-Age Attendance
This field is hidden when viewing the form
School-Age Out of Session Days To Attend
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
School-Age Out Of Session Meals to Attend
Enrolling Parent Information
Name*
This field is hidden when viewing the form
Address*
TYPE OF REGISTRATION
WHAT DAYS WILL YOUR CHILD ATTEND
WHEN WILL YOUR CHILD ATTEND
AFTER SCHOOL ATTENDANCE
BEFORE and AFTER SCHOOL
Additional Parent Information
Name
This field is hidden when viewing the form
Address
Work Address
Custody Information

Legal Guardian must be provided with court issued custody papers that clearly describe the custody arrangements. Any person granted custody in such papers may pick up the child during the times that person has custody and may designate other persons who are authorized to pick up the child at such times, unless court papers state otherwise.

Alternate Pick-up Information
First Alternate
This field is hidden when viewing the form
Name
This field is hidden when viewing the form
Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Second Alternate
This field is hidden when viewing the form
Name
This field is hidden when viewing the form
This field is hidden when viewing the form
Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Third Alternate
This field is hidden when viewing the form
Name
This field is hidden when viewing the form
This field is hidden when viewing the form
Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Medical Information
Emergency Contact Information
Name
Address*
Special Needs Information
Is your child potty trained?
Does your child need help dressing?
Does your child need help eating?
Does your child need help washing hands?
Does your child have any special fears or problems?
Has your child been cared for by anyone other than his/her parents?
Miscellaneous Information
How did you hear about us?
Legal Information

I agree to pay a registration fee at the time of enrollment to be renewed each August/September. This enrollment fee is not refundable, but is transferable to another Legal Guardian. I agree to pay in advance each week’s tuition. I am aware that I will be charged a fee for payments received after 9:00 A.M on Tuesday. I am aware that I will be charged a fee for late pick-ups. You agree to read and download the parent handbook in the Parent Resources section. It is mandatory that all of our Pre School and Pre-K students follow uniform guidelines. This institution is an equal opportunity provider.

Form Acknowledgement

To Digitally Sign this document please check the "Acknowledgement box" and type your full name in the Signature box. You may be asked to physically sign paperwork once you come into our center.

I acknowledge*

I Acknowledge that by entering my full name above I am signing this application and warrant all information I have entered to be true.