Winfield Enrollment Interest Form

WINFIELD Children's House

... fostering a love of learning and inspiring children to be caring, socially responsible citizens of their community and the world.
Interest Form

Thank you for your interest in our programs! Please make a separate entry for each child you want to add.
Child Name*

First NameLast Name
Preferred Name (if different)
Date of Birth (or Due Date)*

MonthDayYear
Gender*

femalemaleOther
Program Selection*

Toddler House (16 months by the start of the school year)Children's House (3 years old by Oct 15 of the year school starts)Children's House / Kindergarten (must turn 5 by October 15)
Parent/Guardian #1*

First NameLast Name
Parent/Guardian #1 Email*
yourname@email.com
Parent/Guardian #1 Phone*

Area CodePhone Number
type
Parent/Guardian #2

First NameLast Name
Parent/Guardian #2 Email
yourname@email.com
Parent/Guardian #2 Phone

Area CodePhone Number
type
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

WINFIELD Children's House