Off To The Farmhouse: Admission Form
I understand that enrollment in this Enrichment Program is limited and participants will be accommodated on a first come, first serve basis.  I understand my child must also be developmentally ready to thrive and engage with animals, activities, and other friends and be able to use the bathroom alone and put on their shoes independently. We are not a daycare or a preschool and are not governed by the State of California as such. We now have an added COVID release form. (Please sign and return w/ payment BEFORE your child’s first meeting.)
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Email *
Which Day Of The Week Are You Registering For? *
Payment Type
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Child's First & Last Name:  *List All Students If More Than One*  (include nickname, if any)
Age(s) today with Birthdates (For All Children Attending) ex: 11/02/14
Mother’s Name:
Email Address:
Cell Phone Number:
Mother's Employer:
Father’s Name:
Email Address:
Cell Phone Number:
Father's Employer:
Siblings (Names/Ages):
Pets (Type/Name):
Home Address: City, State, Zip
Child lives with ONE parent or BOTH parents?
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Emergency Information: In case you cannot be located, list the names and phone numbers of TWO people who are authorized to pick up your child(ren) and/or can take responsibility for your child:
Describe any other schooling your child attends outside of your own home?
Food or any other allergies?                    Wednesday class only: (This will be a place where no peanuts are served, if just ONE has an acute allergy.) Is your child a hearty or picky eater? What foods does he/she like? Veggies? Fruits? Avocado? Hummus? Nut butters? Salami? Cheese?
Currently on any meds? NO or if, Yes, then what?
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Allergic to insects like bees?
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Does your child need regular reminders to use the bathroom?
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Has your child been in child care before? Describe type.
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Is your child comfortable and cooperative in group situations?
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Do you have any concerns about your child’s development (for example, hearing, vision, language, gross motor, fine motor, social, other things)?                If Yes, please explain.
What is your child’s regular routine when at home? Usual bedtime?
Anything we should know about your child's play with other children, by themselves, any concerns? Do they willingly share or is that challenging?
What kinds of activities does your child enjoy? Are there activities your child avoids?
How would you describe your child’s temperament and personality?
What delights your child?
What comforts your child?
What frightens your child (besides the obvious)? Spiders? Insects? The dark?
Does your child have any favorite songs or games?
What are your expectations or hopes for your child during this play/learntime?
Is there anything regarding your family, extended family or child that you would like to share with me that would help us serve your child?
Are you new to this area?
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Is this the first time you’ve dropped off your child for outside care?
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