Online Application

Child Information:

Child's Name:

Address:

Date of Birth:

Adult Information:

Adult 1:

Email 1:

Phone 1:

Adult 2:

Email 2:

Phone 2:

Program Information:

Preferred Length of the Day: Full Day 7:45am-6pmSchool Day 8:40am-3pmMornings 8:40am-12pm

Preferred Days of the Week: 5-days (M-F)3-Days (M-W)2-Days (Th/Fr)

Has your child previously attended daycare or school? If so, which:

Please describe your child including his/her strengths and the things he/she is currently working on:

What are your hopes/expectations for your child through this program?

What is the best time for contacting you?
---morningafternoonevening

What is the best method for contacting you?
---emailphone