The Ivy League Learning Academy Pre-enrollment Form

Full Name of Child*

Date of Birth*

Parent/Guardian's Name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Primary Care Child Classroom(s):

Harvard Classroom: 6 weeks to 1 years old (non-mobile)Stanford Classroom: after turning 1 year to 2 years old (mobile)Columbia Classroom: after turning 2 years to 3 years oldM.I.T. Classroom: after turning 3 years to 5 years old

Other Program(s)

Grade School Tutoring & Homework Help (for grade school students ONLY)Daily Drop-Ins (Hourly) (not available for students applying for primary childcare)Before & After School CareSaturday School (open to the public for ages 6 weeks to 12 years old - must register)Parent’s Night Out (Special Event)Summer School Care ONLY (May through August)

Anticipated Start Date *

Date

FOR SATURDAY SCHOOL ONLY: Please list the Saturday’s date below that you are signing up for.

MM/DD/YY - You have the option to input multiple dates or details for certain conditions i.e (every other Saturday starting..;etc.)

PLEASE NOTE: A registeration fee is required to reserve your student's spot per student per program. After filling out the pre-enrollment form, you will receieve information on next steps via email. Please be sure to check your spam folder for response emails. Thanks so much! We appreciate and value your interest in our programs.

Schedule A Tour Today!

PLEASE NOTE: You are allowed to register your child without scheduling a tour. You will recieve a response phone call or e-mail after submitting the pre-enrollment form but also you can call our office (225) 250 - 5211 or text (225) 433 - 4379 to schedule a time to come-in and register your child. Depending on the circumstances, we may be able to provide a small tour at that particular walk-in time.

REMINDER: Please be sure to check spam folders for any correspondence from ILLA. We thank you!

Were you referred to us?

YesNo

If yes, by whom? If no, how did you hear about us?

THE IVY LEAGUE LEARNING ACADEMY