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Enrollment Form
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* Indicates required question
Child's Name:
*
Your answer
Preferred Name:
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Child's Address:
*
Your answer
Has your child previously been enrolled in school?
*
Yes
No
If yes, please list school(s)
Your answer
Does your child have any allergies? Please list and describe reaction.
*
Your answer
Please describe your child's personality:
*
Your answer
Please describe your child's learning style:
*
Your answer
Please list 3-5 of your child's current interests:
*
Your answer
Please list 3-5 of your child's strengths:
*
Your answer
Does your child have any learning differences or diagnosis that would be helpful for a teacher to know when working with your child?
*
Your answer
Has your child experienced any challenges in learning or reaching milestones?
*
Your answer
Please tell us a little bit about your family:
*
Your answer
Please list any other information you think would be helpful for your child's teacher to know.
*
Your answer
Parent/Guardian 1
Name:
*
Your answer
Relationship to child
*
Your answer
Address: (if different from above)
Your answer
Cell Phone:
*
Your answer
Home Phone:
Your answer
Email:
*
Your answer
Place of Employment:
*
Your answer
Parent/Guardian 2
Name:
Your answer
Relationship to child
Your answer
Address: (if different from above)
Your answer
Cell Phone:
Your answer
Home Phone:
Your answer
Email:
Your answer
Place of Employment:
Your answer
Are you interested in enrolling your child in our before-care program?
*
Yes
No
Maybe
Are you interested in enrolling your child in our after-care program?
*
Yes
No
Maybe
How did you learn about our school?
*
Your answer
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