NOTE: Please keep a copy of the completed packet for your records.

*Registration fee is due once your child has been accepted. The fee is payable through our secure, automated billing system on Brightwheel.

General Application

Date of Application

Month

Day

Year

Date of Birth

Month

Day

Year

Child's First Name

Child's Last name

Address

Phone

Names of Brother and Sisters

Projected Start Date

Preferred Schedule (Time)

Full Day

Father's Name

Mother's Name

Father's Address

Mother's Address

Father's Phone Number

Mother's Phone Number

Father's Email

Mother's Email

Father's Occupation

Mother's Occupation

Father's Work Address

Mother's Work Address

Father's Work Phone Number

Mother's Work Phone Number

Father's Marital Status

Mother's Marital Status

Persons Authorized to pick up child/children and/or contact in case of emergency if neither parent is available:

Name

Relationship

Address

Phone

Child's Place of Birth

Was this a full-term pregnancy?

Does your child have any disabilities, allergies or special issues that we should know about in planning for him/her? If so, please describe here:

Child's Religion

What are your child's special play interest?

Does he/she have any fears (ex. dogs, the dark, thunder)?

Has your child had any difficult times recently (ex.Hospitalization, death in the family, new baby, changing home)?

Please notify us of any important happenings as they occur so that we may be as helpful as possible.

Please note any other information that you believe will be helpful to us as we work with your child in the school setting.

Please notify the director and your child's teacher immediately of any change of allergies or personal information (address, phone numbers, email,or medical information)

NOTE: Please keep a copy of the completed packet for your records. *Registration fee is due once your child has been accepted. The fee is payable through our secure, automated billing system on Brightwheel.

General Application

NOTE: Please keep a copy of the completed packet for your records.

*Registration fee is due once your child has been accepted. The fee is payable through our secure, automated billing system on Brightwheel.