2020-2021 Infant Application for Admission
Please fill out one form for each child. After filling out the form, you will be directed to paypal to pay the application fee.
Child's Name *
Child's Gender *
Date of Birth or Due Date *
MM
/
DD
/
YYYY
Ethnicity
Guardian 1 Name *
Guardian 1 Email *
Guardian 1 Phone Number *
Guardian 2 Name
Guardian 2 Email
Guardian 2 Phone Number
Address (Please include house number, street name, city, state, and zip code) *
Do you have any other children currently enrolled in Abeona House? *
Is your family member eligible for the ChildCare Assistance Program (CCAP)? *
Anything else we should know when considering your application? (Please do not include connections to current Abeona families, teachers, or board members.)
Submit
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