Application

Name of Child(ren):      

Date of Birth(s):  

Today’s Date:

Parent/Legal Guardian Name:

Phone Number:  

Email:

Address:

Employment:

Parent Name/Legal Guardian:

Phone Number:  

Email:

Address:

Employment:

Number of people in your household:

Days Needed:      

Hours Needed (Hours Available 7:30 am-5 pm):

6 and older, do you “homeschool”, traditional school, etc?      

3 -5-year-olds, do you intend (or currently) “homeschool”, traditional school, etc?

What are some important values and interests for your family?  

Feel free to share any groups, classes, co-ops, etc. you are part of.