Toddler Application
Ages 12 - 36 months


Email address *
Schedule Preferences
Anticipated Date of Enrollment *
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How many days would you like your child to attend? *
What is your first schedule preference? *
Required
What is your second schedule preference? *
Required
Contact Information
Child's First Name *
Child's Middle Name *
Child's Last Name *
Child's Date of Birth *
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Child's Gender *
1st Parent's Name *
1st Parent's Email Address *
1st Parent's Primary Phone Number *
1st Parent's Street Address *
1st Parent's City *
1st Parent's State *
1st Parent's Zip Code *
1st Parent's Employer
1st Parent's Work Address
1st Parent's Work Phone
2nd Parent's Name
2nd Parent's Email Address
2nd Parent's Primary Phone Number
2nd Parent's Street Address
2nd Parent's City
2nd Parent's State
2nd Parent's Zip
2nd Parent's Employer
2nd Parent's Work Address
2nd Parent's Work Phone Number
Siblings - Please list siblings name, date of birth, and gender
Family Questionnaire
Please describe the pregnancy and birth ( i.e. c-section, complications during pregnancy and birth, adoption, etc). *
Please describe your child’s daily rhythm from the time they wake up until they go to bed. *
Has your child been in regular out-of-home care before (include where and length of time)? *
Has your child had a regular in-home caretaker who is not a parent? If so, who was the caretaker? *
What types of family activities do you enjoy together? *
Please describe your child’s personality (including strengths and areas you’d like to see strengthened). *
Please describe how your child plays with other children. *
Please describe how your child plays alone. *
Does your child watch T.V., movies, or videos or play computer/tablet games? How often? Do you watch/play with them? *
Are you willing to decrease the amount of your child’s screen time if your teacher feels it would benefit your child? Please answer as fully as you are able. *
What types of food does your child like to eat? *
Develomental Milestones
Please let us know at what age your child accomplished the following milestones.
Crawl *
Sit Up *
Walk *
Grow first tooth *
Speak first word *
Medical History
What illnesses has your child had, particularly including measles, mumps, diphtheria, rubella, shigella, hepatitis (type?), meningitis (type?), salmonella, chicken pox, or giardia? *
Does your child have any allergies or health issues? *
Other
Have you attended a BWK Parent Tour? *
If you have attended a tour, what was the date?
Have you watched our virtual tour? *
If you watched our virtual tour, what was the date?
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How did you hear about this program? If you found us on the web, which websites and search engines, and what words did you search on? *
Anything else you would like to add?
A copy of your responses will be emailed to the address you provided.
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