2018-2019 Children's House, Early Childhood Program New Student Pre-Enrollment Form
Completion and submission of this Enrollment Form does not guarantee nor quantify placement. Placement confirmation will occur in April 2018.

Please submit one form per child you wish to enroll.

Email address *
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Grade Placement *
Legal Guardian Name(s) (First and Last Name) *
Your answer
Contact Number for Guardian listed above
Your answer
Alternate Contact Person/Phone Number
Your answer
Mailing Address (Street Number, Street Name, City, Zip Code) *
Your answer
Does your child have previous daycare or preschool experience? Please list. *
Your answer
Does your child have an IEP or IFSP in place? Note: Children's House does not discriminate based on any disability, gender, race, religion or individual need. This question is solely included to accommodate for transition planning including welcoming your child into our program. *
Schedule preference-please note, preferences are not guaranteed. All spaces are filled on a first come, first serve basis. *
I have read, understand and agree to abide by the information contained herein. Please check each box as you agree. *
Required
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