Application

 
CHILD
Name of Child
Name of Child
For which program are you applying?
Please note: The five day program is open and recommended to all ages. The two day option is open to children three and under, only. Children over age four before December 1 should enroll in the five day program. If you are choosing a two or three day option due to financial reasons, we urge to apply for tuition assistance.
Gender
Parent/Guardian 1
Address
Address
Phone
Phone
Current Status of Parent
Business Phone
Business Phone
Parent/ Guardian 2
Name
Name
Address
Address
Phone
Phone
Business Address
Business Address
Business Phone
Business Phone
Current Status of Parent
Supplemental
Does your child have an existing or pending special ed., special need or IEP document?
Has your child been asked to withdraw from any of these? *