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Student Application
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* Required
Email
*
Your email
School Year:
Are you applying for the current school year (2022-23) or next school year (2023-24)?
*
2022-23
2023-24
Student Information:
Student - First Name
*
Your answer
Student - Last Name
*
Your answer
Student - Nickname
Your answer
Student - Date of Birth
*
MM
/
DD
/
YYYY
Student - Gender
*
Boy
Girl
Student - Current School
Your answer
2022-23 School Year:
Grade Level
*
Toddler (two years old upon enrollment)
Preschool (three years old before August 1, 2022 and potty-trained)
Pre-kindergarten (four years old before August 1, 2022 and potty-trained)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Days and Time - Toddler, Preschool, and Pre-kindergarten Applicants only (not K-6)
5 Full Days (Mon - Fri)
4 Full Days (any four days of your choice)
3 Full Days (any three days of your choice)
2 Full Days (any two days of your choice)
5 Mornings (Mon - Fri)
4 Mornings (any four days of your choice)
3 Mornings (any three days of your choice)
2 Mornings (any two days of your choice)
5 Mornings + Lunch (Mon - Fri)
4 Mornings + Lunch (any four days of your choice)
3 Mornings + Lunch (any three days of your choice)
2 Mornings + Lunch (any two days of your choice)
Clear selection
Extended Care
*
Morning Extended Care (7:00 am - 8:20 am)
Afternoon Extended Care (3:30 pm - 5:30 pm)
Morning and Afternoon Extended Care
No extended Care
Parent Information:
Parent #1 - Relationship to Applicant
*
Mother
Father
Guardian
Parent #1 - First Name
*
Your answer
Parent #1 - Last Name
*
Your answer
Parent #1 - Mobile Phone Number
*
Your answer
Parent #1 - Home Street Address
*
Your answer
Parent #1 - City
*
Your answer
Parent #1 - State
*
Your answer
Parent #1 - Zip Code
*
Your answer
Parent #2 - Relationship to Applicant
Mother
Father
Guardian
Clear selection
Parent #2 - First Name
Your answer
Parent #2 - Last Name
Your answer
Parent #2 - Mobile Phone Number
Your answer
Parent #2 - Email
Your answer
Parent #2 - Home Street Address (if not same as Parent #1)
Your answer
Parent #2 - City
Your answer
Parent #2 - State
Your answer
Parent #2 - Zip
Your answer
Additional Information:
Is there anything that would be helpful for us to know regarding your child's development, behavior, habits, or individual needs?
*
Yes
No
If you answered "Yes" to the previous question, please explain below:
Your answer
A copy of your responses will be emailed to the address you provided.
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