Admission Application Parent / Guardian #1 * First Name Last Name Primary Email * Street Address * Zip Code * Phone * (###) ### #### Relationship to child * Occupation * Parent/Guardian #2 * Phone * (###) ### #### Secondary Email * Street Address * Zip Code * Relationship to child * Occupation Child's Legal Name * Preferred First Name Date of Birth * MM DD YYYY Child's Gender Identification * Please select the program option applying for * 5 days a week 4 days a week Desired Start * MM DD YYYY What are your expectations and desires for your child out of their participation in our program? * Please describe if your child has any special needs, allergies, health concerns, or dietary restrictions? * Do you have any concerns about your child’s social, cognitive, or physical development? * The following special accommodation(s) may be required to most effectively meet my child’s needs while at the school * Is there anything else that you would like to share with us? * Thank you!
