Fall Enrollment Form

STUDENT REGISTRATION AND ENROLLMENT

Please complete the form to begin the registration process. We will be in touch with next steps.
Email *
example@example.com
Name *

First Name Last Name
Cell Phone *

Area Code Phone Number
Home Phone

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
I would like to schedule a tour *

Yes No
Due to safety measures and to eliminate the risk of COVID-19, Zoom tours will be conducted during business hours. Arrangements can be made for an onsite tour of the center after business hours.

Please select a date and time below.
I am interested in enrolling my child(ren) for Check One or Both *

Early Education (Infant through Preschool) eLearning Educare (Elementary School Remote Learning)
Early Education Registration

(Infant through Preschool)
How many children are you registering for this age group? *
Child 1

First Name Last Name
Date of Birth

Month Day Year
Date
Child 2

First Name Last Name
Date of Birth

Month Day Year
Date
Child 3

First Name Last Name
Date of Birth

Month Day Year
Date
Child 4

First Name Last Name
Date of Birth

Month Day Year
Date
Child 5

First Name Last Name
Date of Birth

Month Day Year
Date
eLearning Educare Registration

(Elementary School Remote Learning Support)
How many children are you registering for this age group? *
Child 1

First Name Last Name
Date of Birth

Month Day Year
Date
Grade Entering (2020-2021 School Year)
My child has an accommodation plan (IEP, IFSP, ISP, etc)

Yes No
Type of Plan

IEP - Individualized Education Program IFSP - Individual Family Service Plan ISP - Individual Service Plan
Diagnosis/Reason for Accommodation Plan

Autism ADHD
Upload Accommodations Plan

Browse Files

Cancel of
Child 2

First Name Last Name
Date of Birth

Month Day Year
Date
Grade Entering (2020-2021 School Year)
My child has an accommodation plan (IEP, IFSP, ISP, etc)

Yes No
Type of Plan

IEP - Individualized Education Program IFSP - Individual Family Service Plan ISP - Individual Service Plan
Diagnosis/Reason for Accommodation Plan

Autism ADHD
Upload Accommodations Plan

Browse Files

Cancel of
Child 3

First Name Last Name
Date of Birth

Month Day Year
Date
Grade Entering (2020-2021 School Year)
My child has an accommodation plan (IEP, IFSP, ISP, etc)

Yes No
Type of Plan

IEP - Individualized Education Program IFSP - Individual Family Service Plan ISP - Individual Service Plan
Diagnosis/Reason for Accommodation Plan

Autism ADHD
Upload Accommodations Plan

Browse Files

Cancel of
Child 4

First Name Last Name
Date of Birth

Month Day Year
Date
Grade Entering (2020-2021 School Year)
My child has an accommodation plan (IEP, IFSP, ISP, etc)

Yes No
Type of Plan

IEP - Individualized Education Program IFSP - Individual Family Service Plan ISP - Individual Service Plan
Diagnosis/Reason for Accommodation Plan

Autism ADHD
Upload Accommodations Plan

Browse Files

Cancel of
Child 5

First Name Last Name
Date of Birth

Month Day Year
Date
Grade Entering (2020-2021 School Year)
My child has an accommodation plan (IEP, IFSP, ISP, etc)

Yes No
Type of Plan

IEP - Individualized Education Program IFSP - Individual Family Service Plan ISP - Individual Service Plan
Diagnosis/Reason for Accommodation Plan

Autism ADHD
Upload Accommodations Plan

Browse Files

Cancel of
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STUDENT REGISTRATION AND ENROLLMENT

Early Education Registration

eLearning Educare Registration