Little Wings of Atascadero Enrollment Form
Please fill out all of the following information and one of our Little Wings staff members will be in touch with you as soon as possible!
* Required
Child's Name? (First and Last)
*
Your answer
Child's Gender?
*
Male
Female
Child's Date of Birth
*
MM
/
DD
/
YYYY
1st Parent/Guardian's Name (First and Last)
*
Your answer
1st Parent/ Guardian's Email
*
Your answer
1st Parent/Guardian's Phone Number:
*
Your answer
2nd Parent/Caregiver Name (First, Last)
Your answer
2nd Parent/Caregiver Phone Number:
Your answer
2nd Parent/Caregiver Email:
Your answer
Address
*
Your answer
Does your child currently have any developmental delays? Check all that apply:
Expressive Speech
Receptive Speech
Gross Motor
Fine Motor
Cognitive
Social/Emotional/Behavior
Adaptive Behavior/ Self Help
Not Applicable
Does your child have a diagnosis? (If yes, please list it)
Your answer
Did/does your child receive early intervention services?
*
Yes
No
Maybe
Reason you want your child enrolled in our preschool?
Your answer
Are you interested in Full-Time (8:00 am- 4:30pm) or Part-Time (8am-12pm)?
*
Full Time
Part Time
Which Days of the Week Are You Looking to Enroll Your Child?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Submit
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