Wonder Academy Child Enrollment Application

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Please fill out this application as a first step to your child becoming a part of our Wonder Academy family.

Email *

Date of Application Completion *

YYYY

Date of Enrollment *

YYYY

Child's First and Last Name *

Child's Date of Birth *

Child's Physical Address *

Child Lives With __________ *

Father's/ Parent's Name

Father's/Parent's Phone

Father's/Parent's Address

Mother's/ Parent's Name

Mother's/ Parent's Phone

Mother's/ Parent's Address

Parental Status *

Married

Divorced

Separated

Single

If Divorced of Separated, Who Has Legal Custody *

The child can also be released to the following individuals, as authorized by the person who signs this application. In the event of an emergency, if the parents/guardians cannot be reached, the facility has permission to contact the following individuals. Please include each person's name, relationship, address, number. *

Name of Person not Allowed to Pick Up Child *

HEALTH CARE NEEDS: For any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services, a medical action plan shall be attached to the application. The medical action plan must be completed by the child’s parent or health care professional. Does your child have a medical action plan? *

Yes

List any allergies and the symptoms and type of response required for allergic reactions. *

List any health care needs or concerns, symptoms of and type of response for these health care needs or concerns. *

List any types of medication taken for health care needs. *

Please share any other information that has a direct bearing on assuring safe medical treatment for your child: *

Other pertinent family information you wish to share with us: (i.e., other people residing in the home, etc.): *

Does your child have any habits, needs, schedules or unique behavior characteristics you feel we should know about in attempting to personalize our approach? If yes, please explain in the space provided below. *

Please describe if your child does have any habits, needs, schedules or unique behavior characteristics you feel we should know about. *

Name of health care professional *

Health Care Professional Office Phone *

Hospital Preference *

I, as the parent/guardian, authorize the center to obtain medical attention for my child in an emergency if I register my child at this school. Sign your name by typing your response. *

Date of above signature. *

YYYY

Registration Fee

To officially secure your child's enrollment in one of our classrooms, please enter your credit card information to pay your child's registration fee of $200 for one child and $75 for each additional child.

Name on Card

Billing Address

Zip Code

Credit Card Number

Expiration Date

CVV Code

Wonder Academy as the operator, do agree to provide transportation to an appropriate medical resource in the event of emergency. In an emergency situation, other children in the facility will be supervised by a responsible adult. I will not administer any drug or any medication without specific instructions from the physician or the child’s parent/guardian. *

Yes I acknowledge Wonder Academy's statement above.

No I do not acknowledge Wonder Academy's statement above.

A copy of your responses will be emailed to the address you provided.

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