• Coyote Moon Learning Center Enrollment Form

  • Child's Gender*
  • Child's Grade
  • Lunch

    At Coyote Moon Learning Center, lunch and snack is included in tuition for all enrolled students—there is no additional cost to participate.To help us plan and prepare the appropriate number of meals each day, families are asked to select their child's lunch preference during enrollment.
  • Please select 1 option
  • Before and After School Care

    Before & After Care Is Included with Tuition! We're here to support your family with flexible care that fits your schedule at no additional cost. To participate in our before and after care program, families must complete the Before & After Care below with enrollment.This helps us understand your child's arrival and dismissal schedule so we can provide the best care possible.Space is limited to only 4 students for this program. Signing below ensures we can maintain our small group size and provide each child with the attention they deserve. Please note we open at 6:30am and close at 5:30pm. In the event that you need a later time, please discuss with us before signing.
  • Please select your choice for mornings
  • Please select your choice for afternoon
  • Parental Consent For Media Release

    Throughout the school year, Coyote Moon Learning Center may take photographs, videos, audio recordings, or student work to celebrate learning and share classroom activities.
  • These materials may be used for:

    -School website
    -School Facebook or social media pages
    -Marketing materials, brochures, and flyers
    -Newsletters
    -Classroom displays and school projects

    No personal information (such as home address, phone number, or medical information) will ever be shared.

  • Please Choose One☐
  • All About Student

    Thank you for taking the time to complete this form. The information you provide helps us better understand your child so we can create a positive, supportive, and individualized learning experience.
  • Student Support Goals & Priorities

    At Coyote Moon Learning Center, we work to support each child's unique needs through individualized instruction, speech and language activities, ABA-inspired teaching strategies, and daily life skills. Please help us understand which areas you would like us to focus on this school year.
  • Speech & Communication Goals: Please check any areas you'd like us to support
  • ABA-Inspired Learning GoalsWhat skills would you like us to work on?
  • Life Skills Goals: Please select the skills you'd like your child to practice.
  • Daily Living: Please select skills you'd like your child to practice.
  • Social & Community Skills: Please select areas you would like us to help your child improve in.
  • Date
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