Application for Enrollment (Online) Application Child's Last Name*Child's First Name*Child's Birthdate* MM DD YYYY Child's Gender Female Male Parent/Guardian #1 Last Name*Parent/Guardian #1 First Name*Parent/Guardian #1 Email* Parent/Guardian #1 Cell Phone*Parent/Guardian #2 Last Name*Parent/Guardian #2 First Name*Parent/Guardian #2 Email* Parent/Guardian #2 Cell Phone*Home Address* Street Address City State / Province / Region ZIP / Postal Code Allergies or Food Restrictions (or note None)*Does your child have an Epipen?* Yes No Is there any medical or other condition we should know about?Desired Start Date*This start date is not guaranteed if you are on the waitlistRequested Program* Preschool (2.9 years and older + toilet-trained) Toddler (18 months - 2.9 years + confident walker) Requested Schedule* Full Day (7:30am-6pm) Academic Day (8:30am-3:15pm) Half Day (8:30am-11:30am) How many days per week are you interested in?* 3 4 5 If you selected less than 5 days, please indicate which days you're requesting your child to attend. We highly recommend those days be consecutive (M/T/W, T/W/Th, W/Th/F) Mondays Tuesdays Wednesdays Thursdays Fridays
