Membership Application Form
2021-2022 School Year
Email address *
Mixed age classroom (ages 3-5) My child will be 3 by Sept 1, 2021 *
Are you a returning member? *
Required
Child's Name (Last, First) *
Child's Birthdate *
MM
/
DD
/
YYYY
Child's Gender
Address *
City *
Zip Code *
Parent 1 Name (Last, First) *
Primary Phone Number *
Parent 1 Address (if different from above)
Parent 2 Name (Last, First)
Parent 2 email address *
Secondary Phone Number (optional)
Describe any disabilities or special needs of the child:
Based on interest, there is a sibling nursery available for younger siblings while the parent assists. Do you anticipate using this for the upcoming year? *
Child T-Shirt Size
Method of payment for nonrefundable $35 application fee: *
If paying by check, note the check number below:
How did you hear about Ann Arbor Nursery Inc? *
Have you belonged to a cooperative preschool in the past? *
If yes, what was the name of the co-op?
Offices or jobs previously held
A nonrefundable $35 application fee must accompany this application.
You may pay with cash, check or on the school website with a credit card. Please make check payable to Ann Arbor Nursery Inc. and mail/drop at the school: Ann Arbor Nursery Inc, Attn: Membership Chair, 517 E. Washington St, Ann Arbor MI 48104. Please write your child's name on the Subject area of the check along with "Application Fee." You will receive an email when your application and fee are received.

Returned check policy: If a check is returned from the bank, the family must pay any fees charged to the preschool.
The Ann Arbor Nursery, Inc. admits students regardless or sex, race, color, nation and ethnic origin, religion or sexual orientation.
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