Re-enrollment

Application for Reenrollment *

I would like my child to continue for the upcoming year.
My child will ONLY be enrolled through the summer months.
I will withdraw my child at the end of the school year.

Please select one.

CHILD NAME *

First

Last

CHILD NICKNAME *

CHILD ADDRESS *

CHILD DATE OF BIRTH *

CHILD AGE *

CHILD GENDER *

FATHER NAME *

First

Last

FATHER ADDRESS *

FATHER PREFERRED CONTACT TELEPHONE *

FATHER HOME TELEPHONE

FATHER WORK TELEPHONE

FATHER eMAIL *

FATHER EMPLOYER *

FATHER INFORMATION *

Responsible for Account
Child lives with
Emergency contact
Authorized pickup

Select all that apply.

MOTHER NAME *

First

Last

MOTHER ADDRESS *

MOTHER PREFERRED CONTACT TELEPHONE *

MOTHER HOME TELEPHONE

MOTHER WORK TELEPHONE

MOTHER eMAIL *

MOTHER EMPLOYER *

MOTHER INFORMATION *

Responsible for Account
Child lives with
Emergency contact
Authorized pickup

Select all that apply.

ALTERNATE PICKUP/EMERGENCY CONTACT 1 NAME *

First

Last

ALTERNATE PICKUP/EMERGENCY CONTACT 1 RELATIONSHIP *

ALTERNATE PICKUP/EMERGENCY CONTACT 1 ADDRESS *

ALTERNATE PICKUP/EMERGENCY CONTACT 1 PREFERRED TELEPHONE *

ALTERNATE PICKUP/EMERGENCY CONTACT 1 INFORMATION

Responsible for Account
Child lives with
Emergency contact
Authorized pickup

Select all that apply.

ALTERNATE PICKUP/EMERGENCY CONTACT 2 NAME *

First

Last

ALTERNATE PICKUP/EMERGENCY CONTACT 2 RELATIONSHIP *

ALTERNATE PICKUP/EMERGENCY CONTACT 2 ADDRESS *

ALTERNATE PICKUP/EMERGENCY CONTACT 2 PREFERRED TELEPHONE *

ALTERNATE PICKUP/EMERGENCY CONTACT 2 INFORMATION *

Responsible for account
Child lives with
Emergency contact
Authorized pickup

Select all that apply.

ALTERNATE PICKUP/EMERGENCY CONTACT 3 NAME *

First

Last

ALTERNATE PICKUP/EMERGENCY CONTACT 3 RELATIONSHIP *

ALTERNATE PICKUP/EMERGENCY CONTACT 3 ADDRESS *

ALTERNATE PICKUP/EMERGENCY CONTACT 3 PREFERRED TELEPHONE CONTACT *

ALTERNATE PICKUP/EMERGENCY CONTACT 3 INFORMATION *

Responsible for account
Child lives with
Emergency contact
Authorized pickup

Select all that apply.

PARENTAL AGREEMENT SIGNATURE *

As a parent of a child registering for the upcoming year, I understand that the registration fee is non-refundable after I receive an acknowledgement from the administration accepting my child’s re-enrollment. Approved re-enrollment is based on space availability, current account status, and parent/child harmony with school program. Any concerns regarding my child’s re-enrollment will be addressed before enrollment confirmation given to parent.

Hours & Info

Re-enrollment Due