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Enrollment Application

Nido -- 6 wks. – 15 moToddler -- 15 mo. 3 yrsPrimary -- 3yrs. - 6 yrs

Half Day 8:45 am – 12 noon -- Academic Year Only (August – May)Extended Day 8:45 am – 3 pm -- Academic Year Only (August – May)Half Day 8:45 am – 12 noon -- Academic Year + Summer CampExtended Day 8:45 am – 3 pm -- Academic Year + Summer CampBefore School Care -- 7:00 am – 8:45 amAfter School Care -- 3:00pm – 6:00pm

Child's Information

Both parentsMotherFatherOther
Both parentsMotherFatherOther

Father's Information

Father's Name

Father's Address (if different)




Mother's Information

Mother's Name




Child Release & Emergency Contact Information


Emergency Contact Information

Additional Information:

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