Enrollment Application
Complete your child’s enrollment in just a few minutes. Once submitted, our team will review your application and guide you through the next steps to secure your child’s spot.
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PARENT INFORMATION
Your Parental Status
Select
Full Name
Address
Street Address
City
State
Country
Country
Postal Code
Mobile Phone Number
Email
Place of Birth (City & ST)
Date Of Birth
Social Security Number
Marital Status
Single
Married
Separated
Divorced
Widowed
Are You Currently Employed?
Yes
No
Employer
Occupation
Work Phone
Are you the Primary Guardian?
Yes
No
Is there any other Parent, Legal Guardian or Authorized Caretaker?
Yes
No
Parent, Legal Guardian or Authorized Caretaker Role
Select
Parent, Legal Guardian or Authorized Caretaker Role (Other)
SPOUSE INFORMATION
Do you & your spouse reside in the same household?
Yes
No
Spouse's Full Name
Spouse's Street Address
Spouse's City
Spouse's State
Spouse's Postal Code
Spouse's Email
Spouse's Mobile Number
Spouse's Date of Birth
Spouse's Place of Birth (City & State)
Is Your Spouse Currently Employed?
Yes
No
Spouse's Employer
Spouse's Occupation
Spouse's Work Phone
Is this Spouse a Primary or Secondary Guardian?
Select
EX-SPOUSE INFORMATION
Ex-Spouse Full Name
Ex-Spouse Street Address
Ex-Spouse City
Ex-Spouse State
Ex-Spouse Postal Code
Ex-Spouse Email
Ex-Spouse Mobile Number
Ex-Spouse Date of Birth
Ex-Spouse Place of Birth (City & State)
Is Ex-Spouse Employed?
Yes
No
Ex-Spouse Employer
Ex-Spouse Occupation
Ex-Spouse Work Phone
Is Ex-Spouse an Emergency Contact?
Yes
No
STEPFATHER INFORMATION
Stepfather Full Name
Stepfather Street Address
Stepfather City
Stepfather State
Stepfather Postal Code
Stepfather Email
Stepfather Mobile Phone
Stepfather Date of Birth
Stepfather Place of Birth (City & State)
Is Stepfather Employed?
Yes
No
Stepfather Employer
Stepfather Occupation
Stepfather Work Phone
Is Stepfather an Emergency Contact?
Yes
No
STEPMOTHER INFORMATION
Stepmother Full Name
Stepmother Street Address
Stepmother City
Stepmother State
Stepmother Postal Code
Stepmother Email
Stepmother Mobile Phone Number
Stepmother Date of Birth
Stepmother Place of Birth (City & State)
Is Stepmother Employed?
Yes
No
Stepmother Employer
Stepmother Occupation
Stepmother Work Phone
Is Stepmother an Emergency Contact?
Yes
No
GRANDPARENT(S) INFORMATION
Grandparent(s) Full Name
Grandparent(s) Street Address
Grandparent(s) City
Grandparent(s) State
Grandparent(s) Postal Code
Grandparent(s) Email
Grandparent(s) Mobile Phone Number
Grandparent(s) Date of Birth
Grandparent(s) Place of Birth (City & State)
Is Grandparent(s) Employed?
Yes
No
Grandparent(s) Employer
Grandparent(s) Occupation
Grandparent(s) Work Phone
Is Grandparent(s) an Emergency Contact?
Yes
No
FOSTER PARENT(S) INFORMATION
Foster Parent(s) Full Name
Foster Parent(s) Street Address
Foster Parent(s) City
Foster Parent(s) State
Foster Parent(s) Postal Code
Foster Parent(s) Email
Foster Parent(s) Mobile Phone Number
Foster Parent(s) Date of Birth
Foster Parent(s) Place of Birth (City & State)
Is Foster Parent(s) Employed?
Yes
No
Foster Parent(s) Employer
Foster Parent(s) Occupation
Foster Parent(s) Work Phone
Is Foster Parent(s) an Emergency Contact?
Yes
No
AUTHORIZED CARETAKER INFORMATION
Authorized Caretaker Full Name
Authorized Caretaker Street Address
Authorized Caretaker City
Authorized Caretaker State
Authorized Caretaker Postal Code
Authorized Caretaker Email
Authorized Caretaker Mobile Phone Number
Authorized Caretaker Date of Birth
Authorized Caretaker Place of Birth (City & State)
Is Authorized Caretaker Employed?
Yes
No
Authorized Caretaker Employer
Authorized Caretaker Occupation
Authorized Caretaker Work Phone
Is Authorized Caretaker an Emergency Contact?
Yes
No
LEGAL GUARDIAN INFORMATION
Legal Guardian Full Name
Legal Guardian Street Address
Legal Guardian City
Legal Guardian State
Legal Guardian Postal Code
Legal Guardian Email
Legal Guardian Mobile Phone Number
Legal Guardian Date of Birth
Legal Guardian Place of Birth (City & State)
Is Legal Guardian Employed?
Yes
No
Legal Guardian Employer
Legal Guardian Occupation
Legal Guardian Work Phone
Is this Legal Guardian an Emergency Contact?
Yes
No
CHILD'S INFORMATION
Child Full Name
Date of Birth (DOB)
Who Does the Child Lives With?
Select
Who Does the Child Live With? (Other)
Who Has Legal Custody of the Child?
Select
Child Identifier (PLEASE ENTER "TBD" HERE)
*
Does Child Have Any Siblings?
Yes
No
How Many Siblings Does Child Have?
Select
SIBLING (#1)
Sibling (1): Name
Sibling (1): Age
Sibling (1): Grade
Sibling (1): School
SIBLING (#2)
Sibling (2): Name
Sibling (2): Age
Sibling (2): Grade
Sibling (2): School
SIBLING (#3)
Sibling (3): Name
Sibling (3): Age
Sibling (3): Grade
Sibling (3): School
SIBLING (#4)
Sibling (4): Name
Sibling (4): Age
Sibling (4): Grade
Sibling (4): School
CHILD'S MEDICAL & EMERGENCY INFORMATION
Does Child Have Any Allergies?
Yes
No
Please List All Child's Allergies (1 Per Line)
Are You Providing Child With an Inhaler?
Yes
No
Are You Providing Child With an Epipen?
Yes
No
Are You Providing Child With Any Medications?
Yes
No
Which Medications Are You Providing Child With? (1 Per Line)
Please describe any illnesses, diseases, mental, emotional or physical disabilities which may affect your child’s general progress or participation in the classroom or in any other school related activities (If Applicable)::
Has Child Ever Been Tested For a Learning Disability and/or Attention Deficit Disorder?
Yes
No
Please Upload Any & All Result Documents from Learning Disability and/or Attention Deficit Disorder Testing:
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 6 Files )
PHYSICIAN & INSURANCE INFORMATION
Medical Doctor or Office Name
Medical Doctor or Office Phone
Dentist or Dental Office Name
Dentist or Dental Office Phone
Preferred Hospital
Preferred Hospital Phone
Insurance Carrier Name
Insurance Policy Number
Insurance Group Number
Insurance Carrier Phone Number
