Admission Application

PARENT / GUARDIAN INFORMATION

Full Name *
Address *
Phone *
Email *
Employer

Verification Documents (Required)

Driver’s License *

Proof of Current Address *

Documents are used for verification purposes only and handled securely.

CHILD(REN) INFORMATION

Name
Age
Current School

Academic Goals
Preferred Language
Allergies

Office Use Only

PROGRAM INFORMATION

MEMBERSHIP INFORMATION

Single Child Two Children Three Children Four Children

MEAL PLAN

Breakfast Lunch Dinner

EMERGENCY CONTACT INFORMATION

Name *
Relationship *
Phone *
Email

Government ID *

Emergency contacts must present valid identification.

PICK-UP & DROP-OFF AUTHORIZATION

Authorized Person Name *
Relationship *
Phone *

Government ID *

Authorized individuals must present valid ID at pick-up.

Parent / Guardian Signature

Date