Application

Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Parent/Guardian's Name *

First Name

Last Name

Phone *

(###)

###

####

What was the date of your tour?

MM

DD

YYYY

Which class sessions are you interested in? *

Fall

Winter

Spring

School Year

Which days are you interested in? *

Monday

Tuesday

Wednesday

Thursday

Friday

Full week

Whatever is available

What class session would you prefer?

Morning (9 -12)

Morning including lunch (9 -1)

Afternoon (12-3)

Full Day (9-3)

How many days are you interested in? *

1

2

3

4

5

Has your child attended a drop-off program before? *

Yes, and my child has been able to separate from family with ease at drop off.

Yes, and my child experiences some difficulty separating from family for a few minutes at drop off.

Yes, and separation is very difficult for my child.

No, my child has not attended any drop off programs yet.

Is your child potty trained?

Yes

No

In process