Enroll your child in our kindergarten

Download the form in pdf format

form

or use the online enrollment form

APPLICATION/RECORD OF INFORMATION ABOUT THE CHILD

Child's name

Date of birth

Sex

Address

Date of entry

Date of discharge

PARENT OR OTHER PERSON PLACING THE CHILD

First Name, Last Name

Relationship to the child

Home address

Phone No.

Place of employment

Work address

Business phone

Hours of operation

Another person

First Name, Last Name

Relationship to the child

Home address

Phone No.

Place of employment

Work address

Phone No.

Hours of operation

OTHER PERSONS TO BE NOTIFIED IF THE PERSON PLACING THE CHILD CANNOT BE REACHED

First Name, Last Name

Address

Phone No.

Relationship to the child

First Name, Last Name

Address

Phone No.

Relationship to the child

A DOCTOR TO CALL IF YOUR CHILD GETS SICK OR INJURED

First Name, Last Name

Address

Phone No.

Hospital or Clinic

PROGRAM

Number of days per week

Hours of care

INFORMATION ON CHILD DEVELOPMENT

Language(s) spoken by the child

HEALTH HISTORY

Does your child have any health problems?

Is your child taking any medications? (Specify name/dose/frequency)

Does your child have any allergies?

Does your child have any play restrictions (outdoor/indoor)?

Has your child had a developmental or diagnostic evaluation?

Does your child receive any special services (i.e. Speech, OT, behavioral therapy, etc.)?

RUTIN

Liked food

Disliked foods

Fear / Phobias

Is the baby asleep?

Does the child have special names for objects? (potty, cookies, drinks, etc.).

What behaviors of your child are "hard to deal with"?

Other useful information