Enrollment Form
Please fill out this form for enrollment to the Hempstead Special Needs Center. 
Sign in to Google to save your progress. Learn more
Email *
How many children will be attending? *
What is the name of your child/children? *
How old is your child/children? *
How many days a week will your child/children be attending. Open Monday-Saturday
If your child/children has an intellectual disability, please describe it below: *
What does your child/children enjoy working for? *
Is there anything that your child/children does not like? *
Does your child/children have any allergies? If yes, please explain: *
Will your child/children take any medication while at the center? If yes, please explain: *
Parent/Guardian contact info: *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy