Winfield Enrollment Interest Form

Child Name*

First NameLast Name

Preferred Name (if different)

Date of Birth (or Due Date)*

femalemaleunborn

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)

Please make your schedule selection(s) below, ranked in order of preference

Toddler House Schedule Selection

Rows	1	2	3	4
5 Full Days: M - F
4 Full Days: M-T-Th-F
3 Full Days: T-W-Th
3 Full Days: M-W-F
5 Mornings: M - F
4 Mornings: M-T-Th-F
3 Mornings: T-W-Th
3 Mornings: M-W-F

Children's House Schedule Selection

Rows	1	2	3	4
5 Full Days: M - F
4 Full Days: M-T-Th-F
3 Full Days: T-W-Th
3 Full Days: M-W-F
5 Mornings: M - F
4 Mornings: M-T-Th-F
3 Mornings: T-W-Th
3 Mornings: M-W-F

Kindergarten Program Schedule Selection

Rows	1	2	3	4
5 Full Days: M - F
5 Mornings+4 Full Days: M-T-Th-F
5 Mornings+3 Full Days: T-W-Th
5 Mornings+3 Full Days: M-W-F
5 Mornings: M-F

Parent/Guardian completing this form:*

First NameLast Name

Email*

yourname@email.com

Parent/Guardian Phone*

Format: (000) 000-0000.

type

Parent/Guardian #2

First NameLast Name

Parent/Guardian #2 Email

yourname@email.com

Parent/Guardian #2 Phone

Format: (000) 000-0000.

type

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

123

Child #2 Name

First NameLast Name

Preferred Name #2 (if different)

Date of Birth (or Due Date) #2

femalemaleOther

Please make your schedule selection(s) below, ranked in order of preference

Child #3 Name

First NameLast Name

Preferred Name #3 (if different)

Date of Birth (or Due Date) #3

femalemaleOther

Please make your schedule selection(s) below, ranked in order of preference

Winfield Relationship*

Is there anything you'd like us to know?

By submitting this form, I am expressing interest in Winfield's programs for my child(ren) and would like to be contacted by Winfield staff. I understand I am not under obligation to proceed with enrollment and that no agreement or guarantee of enrollment is implied by Winfield in the acceptance of this form.

Signature

Parent/Guardian completing this form:*

First NameLast Name

Today's Date

Date

Please send confirmation email to:*

example@example.com

WINFIELD Children's House

Interest Form