Name of person completing this form, and relationship to child(ren): *

Child 1 First Name *

Child 1 Last Name *

Child 1 Date of Birth *

Does Child 1 have any known health conditions/allergies? If yes, please explain *

Child 2 First Name (if none, type N/A)

Child 2 Last Name (if none, type N/A)

Child 2 Date of Birth (if none, leave blank)

Does Child 2 have any known health conditions/allergies? If yes, please explain

Child 3 First Name (if none, type N/A)

Child 3 Last Name (if none, type N/A)

Child 3 Date of Birth (if none, leave blank)

Does Child 3 have any known health conditions/allergies? If yes, please explain

Requested Start Date (must be at least two weeks from date of of filling out this form) *

(For Infants through Junior Kindergarten ONLY) My child(ren) will be attending: *

A normal drop off time for my child(ren) will be: *

I understand that drop off time for the ELC is from 6am to 915am. Please type your initials below to confirm. *

Parent 1 Name *

Parent 1 Email *

Parent 1 Phone Number *

Parent 2 Name *

Parent 2 Email *

Parent 2 Phone Number *

All forms can be found at tlsonline.org/elc-parents, and I understand that all of the following paperwork must be submitted prior to my child(ren)'s start date: *

My child(ren)'s brightwheel account(s) are up to date with the requested information below (if you're a new family, this account will be created once we've reviewed your enrollment application): *

I understand that my registration fee is due at time of enrollment and prior to my child(ren)'s start date, and I will pay through brightwheel billing. Type your initials below to confirm. *

Will your child(ren) need to have any medications on site at the ELC? If yes, please explain. *

Is your child(ren) currently taking medications? *

I understand that if my child(ren) need to have medication on site that I am required to provide the following- the medication, labeled with a pharmacy label including all information; the appropriate medication administration form completed with accurate instructions from the provider; medication and forms that are up to date and not expired. Type your initials below to confirm. *

Does your child have a 504 plan? *

Does your child have an IEP or an IFSP? *

If you are enrolling in before and after care (K-8 ONLY), please answer the following

I understand that at anytime, the policies and procedures may change with notice from the director based upon updated guidelines from the Office of Childcare and/or the CDC and local health department. I also understand that I am responsible for following all guidelines. Type your initials below to confirm. *

Type your signature along with today's date below to confirm your application for enrollment for Trinity's ELC. *