ELC Enrollment Form, 2021.2022
Ready to join our family, or to continue your time with us? Please fill this form out for enrollment in the Trinity ELC. This form is for 6 weeks through 5 years and also for ages 5+ for summer care, drop in care, and before and after care.
Email address *
Name of person completing this form, and relationship to child(ren): *
Child 1 First Name *
Child 1 Last Name *
Child 1 Date of Birth *
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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)
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DD
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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)
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DD
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YYYY
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) *
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(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: *
Required
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): *
Required
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
Clear selection
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. *
A copy of your responses will be emailed to the address you provided.
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