Enrollment Application
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1For office use only
Enrollment
Session enrolled for: __________________ Starting day/year: ______________
Application
Special Comments: _________________________________________________
Child’s full name _____________________________________________________
Age __________
Birthdate _________
Home address _______________________________________________________
Phone ____________________________
City _________________________________________________ Zip __________
Boy __________
Girl _____________
School last attended __________________________________________________
Father
Stepfather
Legal Guardian (check one)
Name ___________________________________________
Address _______________________________________________
Employed by _____________________________________
Occupation ____________________________________________
Employer address _____________________________________________________________ Work phone _________________
Email address ________________________________________________________________
Mother
Stepmother
Legal Guardian (check one)
Name ___________________________________________
Address _______________________________________________
Employed by _____________________________________
Occupation ____________________________________________
Employer address _____________________________________________________________ Work phone _________________
Email address ________________________________________________________________
Married
Living Together
Separated
Divorced
Other
Marital Status: (check one)
Brothers and Sisters:
Name __________________________________________________________________________________
Age _________
Name __________________________________________________________________________________
Age _________
Name __________________________________________________________________________________
Age _________
List names of persons authorized to take child from school. Child WILL NOT be allowed to leave with any other person
without WRITTEN authorization.
Name
Address
Phone
Relationship
Name
Address
Phone
Relationship
Name
Address
Phone
Relationship
Name
Address
Phone
Relationship
Parent Signature: _________________________________________________________ Date: __________________
Director Signature: ________________________________________________________ Date: __________________
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Parent category: Education