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Infant-Toddler Program
Pre-K / KG Program
Infant-Toddler Application
If you are looking for the Pre-K / Kindergarten application
click here
.
Select Program
AM Program 9:00 a.m. - 12:00 p.m.
PM Program 12:00 p.m. - 3:00 p.m.
Extended Day 9:00 a.m 3:00 p.m.
Frequency
2 Days
3 Days
5 Days
Frequency
3 Days
5 Days
Student's Full Name Name
First
Middle
Last
Name Used / Nickname
Gender
Male
Female
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Date of Birth
Date Format: MM slash DD slash YYYY
Age in August
Present School / Daycare
Number of Years in System
Start Date
Date Format: MM slash DD slash YYYY
Is another child in your family applying?
Yes
No
Mother's Info
Mother's Name
*
First
Last
Mother's Email
*
Mother's Phone
Mother's Occupation
Mother's Business Phone
Father's Info
Father's Name
First
Last
Father's Email
Father's Phone
Father's Occupation
Father's Business Phone
Physician Info
Physician's Name
First
Last
Physician's Phone
Physician's Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
May the school call another physician if unable to contact the above?
Yes
No
Emergency Contact Info
Other person to be notified in case of illness or accident:
Name
First
Last
Relationship
Phone
People permitted to pick up the child
Mother
Yes
No
Father
Yes
No
Other people permitted to pick up the child:
Name
First
Last
Relationship
Phone
Name
First
Last
Relationship
Phone
Additional Info
Does your child have any difficulties with:
Eyes
Ears
Speech
Are there any conditions in the family that might affect the adjustment of the child?
Name and ages of siblings or other members in the family:
Special instructions or areas of concern:
This form must accompany a registration fee of $250.00 to reserve a spot for your child. The registration fee is non-refundable, and non-transferable. *All applications are based off of a first come, first serve basis, and therefore submitting an application does not guarantee admission.
Parent's Name
First
Last
Parent's Signature
Date
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.
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Programs
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About
Curriculum
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Contact
Request a Tour
Infant-Toddler Program
Pre-K / KG Program
NOW SERVING GOTHA/WINTER GARDEN
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