Future Scholars Academy Registration

Welcome !

I look forward to serving you and your future scholar !
Program For Enrollment *
Child's Name*

First NameLast Name
Center*
Child’s Date of Birth

MonthDayYear
Date
Childs Gender*
Ethnicity*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade if Applicable
What School does your child attend?
Parent/ Guardian*

First NameLast Name
Parent/ Guardian Cell Number*

Area CodePhone Number
Will your child need transportation ?
Parent/ Guardian Place Of Employment
Parent/ Guardian Work Number

Area CodePhone Number
Parent/ Guardian Email*
example@example.com
Second Parent/ Guardian Name

First NameLast Name
Second Parent/ Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Legal Guardian(s)*

Both ParentsMotherFatherOther

Emergency Contact*

	First Name	Last Name	Phone Number
Emergency Contact 1
Emergency Contact 2
Emergency Contact 3
Emergency Contact 4

Authorized pickups (for individuals over 18 years old who have your permission for FSA/CST to release your child.)*

	First Name	Last Name	Phone Number	Relationship
Pickup Contact 1
Pickup Contact 2
Pickup Contact 3
Pickup Contact 4

Primary Physician

First NameLast Name
Phone Number

Area CodePhone Number
Child's Medication
Child's Allergies
Addl. Info
Upon submission of your form, you will receive a follow-up call from our Director, who will provide detailed orientation information and further instructions. Please note that enrollment is not finalized until all required fees and forms have been submitted. Additionally, tuition must be current before your child’s first day of attendance.

We are excited to partner with you and welcome your Future Scholar to our program! Should you have any questions, please do not hesitate to contact us.
Signature*
To schedule a tour of our facility or meet with our Director please schedule below. Appointments are encouraged as our policy prohibits impromptu visits to maintain safety measures.

My Products

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FSA Aftercare Registration $100.00

This is a yearly non-refundable fee.

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Extended Care Registration $125.00

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Future Scholars Early Learning & Preschool Program $125.00

This is a yearly non-refundable fee.

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Summer Camp (Early Registration ONLY)$75.00

This is a non-refundable fee.

Consultation 1 hour$50.00

This is perfect for aspiring childcare prociders who want guidamce, clarity, and confidence to opening a childcare facility.

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Total $0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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