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Forms


2015-16 APPLICATION FOR ADMISSION                                

Date _____________

$30 Application Fee per child_____

Child’s Name ___________________________ Gender _____          Birth date ____________

Home Address: _________________________          Zip ________     Home Phone: ______________

Mother’s Name _________________________          Father’s Name _________________________

Place of Employment ____________________        Place of Employment _____________________

Cell Phone # ___________________________            Cell Phone # ___________________________

E-Mail ________________________________      E-Mail________________________________

Names of Siblings                                                                                        Birth Date

_________________________________________________________    ____________

_________________________________________________________    ____________

Please register my child for the following program:

(  )  Six session Parent-Infant Course  for  4 month  to 18+ months –  (9:30 -11:00 AM)

(  )  Four morning Toddler program – 18 months to 36 months, (8:30 – 11:30 AM)

(  )  Five morning Primary program – 3 to 4 year olds, (8:30 – 11:30 AM)

(  )  Extended-day Primary program – 3, 4, year olds and kindergarten-aged,  (8:30 AM- 3:00 PM)

(  )  Five day Elementary program – 6 to 9 year olds, (8:30 AM – 3:00 PM)

Supplementary Hours for Primary & Elementary children only:

(  )  Before School Care (7:30 – 8:30 AM)

(  )  After School Care   (3:00 – 4:00 PM)

(  )  Extended After School Care (3:00 – 5:00PM)

 

Another emergency contact person ___________________________                  Relation to Child ____________

Daytime ph # ____________________  Cell ph#  ____________________  Comments: ________________

______________________________________________________________________________________

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