Student Application
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Email *
School Year:
Are you applying for the current school year (2022-23) or next school year (2023-24)? *
Student Information:
Student - First Name *
Student - Last Name *
Student - Nickname
Student - Date of Birth *
MM
/
DD
/
YYYY
Student - Gender *
Student - Current School
2022-23 School Year:
Grade Level *
Days and Time - Toddler, Preschool, and Pre-kindergarten Applicants only (not K-6)
Clear selection
Extended Care *
Parent Information:
Parent #1 - Relationship to Applicant *
Parent #1 - First Name *
Parent #1 - Last Name *
Parent #1 - Mobile Phone Number *
Parent #1 - Home Street Address *
Parent #1 - City *
Parent #1 - State *
Parent #1 - Zip Code *
Parent #2 - Relationship to Applicant
Clear selection
Parent #2 - First Name
Parent #2 - Last Name
Parent #2 - Mobile Phone Number
Parent #2 - Email
Parent #2 - Home Street Address (if not same as Parent #1)
Parent #2 - City
Parent #2 - State
Parent #2 - Zip
Additional Information:
Is there anything that would be helpful for us to know regarding your child's development, behavior, habits, or individual needs? *
If you answered "Yes" to the previous question, please explain below:
A copy of your responses will be emailed to the address you provided.
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