Enrollment Application "*" indicates required fields Child's Name (First and Last)*Due Date/Date of Birth* MM slash DD slash YYYY Parent(s) Full Name*Preferred Contact Number*Email* update Check here to receive email updates. Start Date Needed* MM slash DD slash YYYY Enrollment* Full-Time (M-F) Part Time (3 Set Days/Week) If Part-Time, what days will your child attend?Describe your child’s prior experience in a childcare setting*For children 2 and older: is your child potty trained? If not, are you working on it at home & are they in diapers, pullups, or underwear?*Is there anything in the child’s personal life or home environment that would affect their enrollment at our facility (custody, living situation, visitations, etc.)*Is your child up to date on immunizations? (we are a fully immunized center, so we cannot take exemptions)* Yes No Describe any physical, developmental or behavioral concerns you or your child’s pediatrician might have (our classrooms are large, so some children with behavior difficulties do not adjust well & we would recommend a center with smaller classrooms)*Any additional information that would be helpful in the care of your childCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
