New Student Application

Date

Month Day Year

Applying for Grade

Student Name*

First Name Last Name

Birth Date*

Month Day Year

Gender

Male Female

Start Date*

Month Day Year

5 Days

M - F

4 days

Monday Tuesday Wednesday Thursday Friday

3 Days

Monday Tuesday Wednesday Thursday Friday

2 Days

Monday Tuesday Wednesday Thursday Friday

Schedule

Full Day 8:00 - 3:30 Half Day 8:00 - 12:30

I will be requesting extended care.

Parent Name #1*

First Name Last Name

Phone Number*

Area Code Phone Number

E-mail*

Address*

Parent Name #2

First Name Last Name

Phone Number

Area Code Phone Number

E-mail

Address If differs from above

Application for Preschool WAITING LIST