Untitled Document
REGISTRATION

APPLICATION FOR ENROLLMENT OF NEW STUDENTS Printable Version

School Year: 20

Child Identification
First Name of Child:
Last Name of Child:
Nickname of Child:
Child's Date of BIrth:
Street Address:
City:
State:
Zip Code:
Phone Number:

Mother or Guardian
First Name:
Last Name:
Maiden Name:
Employer:
Work Phone:
Cell Phone:
Email Address:

Father or Guardian
First Name:
Last Name:
Employer:
Work Phone:
Cell Phone:
Email Address:

If either parent or guardian is a student, please list name of school, school phone number, and current schedule.
School:
Phone Number:
Hours: Class Name:

List persons authorized to pick up your child:
UNDER NO CIRCUMSTANCES WILL YOUR CHILD BE RELEASED TO ANYONE NOT KNOWN TO THE SCHOOL WITHOUT AUTHORIZATION FROM PARENTS OR GUARDIAN.
Name:
Relationship:
Name:
Relationship:
Name:
Relationship:
I will bring my child about:
I will pick up my child about:
I will bring my child on these days (Select all that apply): Mon - Fri Monday Tuesday 'Wednesday
Thursday Friday
Date you would like to start: or Not Sure

 

  

A registration fee of $65.00 must accompany this application.
If you e-mail the application, please understand that we cannot hold a spot for you until the registration fee is paid. Or, you can simply print the form and drop it by the center with payment at your earliest convenience.

Untitled Document Copyright 2011 Stepping Stone
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