Parent-Child Winter Sessions
Sessions are limited to nine (9) families
Fridays from January 13th - March 31st (10 weeks) $250
We will not have any sessions on March 24th
Is your child a returning Rock Rose Parent-Child student?
Child's Name
Your answer
Child's Gender
Date of Birth
Your answer
Please select your age group
Required
Family Information
Child's Mother/Guardian
Your answer
Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Email Address
Your answer
Occupation and Employer
Your answer
Child's Father/Guardian
Your answer
Address (if different from above)
Your answer
Home Phone (if different from above)
Your answer
Cell Phone
Your answer
Email Address
Your answer
Occupation and Employer
Your answer
Legal Custody of Child
Names and Ages of Siblings
Your answer
Mailing Address (if different from above)
Your answer
Developmental History
Please describe your pregnancy
Your answer
Please describe your child's birth
Your answer
What was your child like as a baby?
Your answer
What age did your child begin to walk?
Your answer
What age did your child begin to talk?
Your answer
Does your child receive any special services, occupational therapy, speech therapy, etc?
Your answer
Daily Routines
What time does your child wake up?
Your answer
What time does your child go to bed?
Your answer
Does your child nap during the day? If yes, when and for how long?
Your answer
Health
Has your child had any serious/severe illnesses or accidents?
Your answer
Does your child have frequent colds?
Your answer
Do you have any medical concerns?
Your answer
Is the child presently under a doctor's care? If yes, what is the name of the doctor?
Your answer
Does your child take any prescribed medications? If yes, what type(s)?
Your answer
Does your child use any special device(s)? If yes, what kind?
Your answer
Diet Patterns
What does your child usually eat for breakfast?
Your answer
What does your child usually eat for lunch?
Your answer
What does your child usually eat for dinner?
Your answer
Does your child have any food dislikes or allergies?
Your answer
Personality and Social Interactions
What is your evaluation of your child's personality?
Your answer
How does your child get along with parents, siblings, and other children?
Your answer
Has your child had any group play experiences? If yes, please describe.
Your answer
Does your child have any special problems/fears/needs that we should be aware of?
Your answer
What other classes, activities is your child enrolled in?
Your answer
What are you looking for in a Parent-Child experience for you and your child?
Your answer
Waldorf
Why do you feel your child would be a good fit for our program?
Your answer
Are you familiar with the Waldorf Philosophy of Early Education?
Your answer
Are you willing to commit to be media free?
Anything else you want to tell us about your child or your family.
Your answer
Next Step
Once your application has been reviewed, we will contact you in order to notify you if a place is available in the session you indicated. If there is no longer a space, would you like to be placed on the waiting list?
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