Membership Application Form
2017-2018 School Year
Class:
Required
Are you a returning member?
Required
Child's Birthdate
MM
/
DD
/
YYYY
Child's Gender
Your answer
Address
Your answer
City
Your answer
Zip Code
Your answer
Primary Phone Number
Your answer
Child's Name (Last, First)
Your answer
Secondary Phone Number (optional)
Your answer
Primary email address
Your answer
Parent 1 Name (Last, First)
Your answer
Parent 2 Name (Last, First)
Your answer
Parent 1 Address (if different from above)
Your answer
Describe any disabilities or special needs of the child:
Your answer
Based on interest, there is a sibling nursery available for younger siblings while the parent assists. Do you anticipate using this for the upcoming year?
Method of payment for nonrefundable $35 application fee:
If paying by check, note the check number below:
Your answer
How did you hear about Ann Arbor Nursery Inc?
Have you belonged to a cooperative preschool in the past?
If yes, what was the name of the co-op?
Your answer
Offices or jobs previously held
Your answer
A nonrefundable $35 application fee must accompany this application.
You may pay with cash, check or on the school website with a credit card. Please make check payable to Ann Arbor Nursery Inc. and mail/drop at the school: Ann Arbor Nursery Inc, Attn: Membership Chair, 517 E. Washington St, Ann Arbor MI 48104. Please write your child's name on the Subject area of the check along with "Application Fee." You will receive an email when your application and fee are received.

Returned check policy: If a check is returned from the bank, the family must pay any fees charged to the preschool.

The Ann Arbor Nursery, Inc. admits students regardless or sex, race, color, nation and ethnic origin, religion or sexual orientation.
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