West Hill Educare - Application for Enrollment
West Hill Educare - Application for Enrollment
Sign in to Google to save your progress. Learn more
Thank you for your interest in West Hill Educare!

When are you hoping to enroll your child? (Date)
Captionless Image
MM
/
DD
/
YYYY
Child's First Name
Child's Last Name
Name Used
Date of Birth *
MM
/
DD
/
YYYY
Home Address (please include address number and street, city and zip code)
Phone Number 
Parent/Guardian 1, First Name *
Parent/Guardian 1, Last Name *
Home address (if different)
Phone Number *
Email *
Talents, hobbies, special interests
Occupation
Name of Firm
Business Phone
Parent/Guardian 2, First Name
Parent/Guardian 2, Last Name
Home address (if different)
Phone Number
Email
Talents, hobbies, special interests
Occupation
Name of Firm
Business Phone
What kind of care, if any has your  child received by people other than their parents?
(day care, playgroups, time with grandparents, babysitters or other adults) *

What do you hope your child will gain from attending West Hill Educare?

 *
Tell us a little about your child. What are they like? 
What makes your child happy? 
What upsets them? What comforts them? 
How do they usually calm themself down? 
How is your child with groups of people? 
What about friendships? 
Tell us about your child's home life. Who do they live with? Any pets? 
What is your child's home language? 
Does your child have any known speech/hearing problems or learning challenges?
If so, please tell us a little these challenges and any support you're receiving.
Tell us about your child's interests. 
What gets them excited? 
What are some activities that they enjoy? 
Any fears that you know of? 

Does your child have any physical limitations? What are some large and small motor skills they enjoy? Are there any physical skills they need support with?

 *

Tell us about your child's cognitive development. What are they good at? What area do you think they need support? (problem solving, exploring, curiosity, imaginary play, modeling others, language skills, math concepts such as counting, patterning, sorting, shapes). Is there a cognitive skill you would like us to work on with your child?

Does your child have any food allergies or diet restrictions? What is their favorite food? Least favorite? 

 *
If your child has special medical needs or non-food related allergies, please note them here: 
Has your child ever been stung by a bee?
Clear selection

Please tell us about your child’s current napping schedule/routine:

Have there been any notable occurrences in your child’s life? (hospitalization, moving, divorce, etc.) 

Do you have any additional comments that you feel may add to our understanding of your child and his/her needs? (adoption, special family circumstances, specific ways of reacting or behaviors, etc.)

How did you learn about West Hill Educare?
Is there a friend or co-worker we can thank for referring you to us?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms