UM-D ECEC 2016-2017 KINDERGARTEN APPLICATION
DUE WITH DEPOSIT ON OR BEFORE MARCH 28, 2016.
Child's First Name
Your answer
Child's Last Name
Your answer
Child's Birthdate:
MM
/
DD
/
YYYY
Please check this box if the child's mother or father will be a UM-Dearborn student in 2016-2017.
Mother's Email Address
Your answer
Father's Email Address
Your answer
Scheduling Options
Please check box below to acknowledge the minimum kindergarten schedule.
Required
EXTENDED CARE: Please schedule my child for EARLY DROP OFF (7:30-8:00 A.M.) on the following days:
EXTENDED CARE: Please schedule my child for AFTERNOON EXTENDED CARE (3:30-5:00 P.M.) on the following days:
EXTENDED CARE: Please schedule my child for LATE STAY (5:00-5:30 P.M.) on the following days:
Please confirm your schedule request by clicking the box below.
(Schedule changes may be requested during the school year and are subject to availability and approval.)
Required
CHILD'S DEVELOPMENTAL / HEALTH HISTORY
If your child has received a previous assessment, you will be required to provide a copy of the assessment at an initial enrollment meeting.
In order to best serve your child, please include any services or assessment your child may have received or any special needs your child may have.
Please check all that apply.
Required
Please provide a detailed explanation of any special needs your child may have (if applicable).
Your answer
OPTIONAL
For statistical purposes only, please indicate which of the following best describes your child's racial/ethnic background.
DEPOSITS
Your 2016-2017 Kindergarten Application must be accompanied by a total of $450 (a $400 deposit + a $50 registration fee). Payment options are as follows:

1. You may mail or drop off a check or cash to the office on or before the due date (March 28, 2016).

2. You may click on the link to our online payment site to pay by credit card after you submit this form. If you are not paying by credit card you can exit from the payment site after you submit. YOUR REQUEST WILL NOT REVIEWED UNTIL YOUR DEPOSIT IS PROCESSED.

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