Parent/Guardian #1
Registration of Interest in Placement at Shady Lane School
Thank you for your interest in enrolling your child in the Shady Lane School five-day program. A $25 registration fee is required to register this intent, though the fee is waived if you qualify for subsidized childcare funding. Once the form is submitted, your child will be added to our waitlist. Please be sure to schedule your tour to view our beloved school and learn more about the admission process. We look forward to meeting you and your family!
Child's Name
*
First Name
Middle Name
Last Name
Suffix
Child's Birth Date
*
-
Month
-
Day
Year
Date
Child's Sex
*
Male
Female
Unknown
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Name
*
First Name
Last Name
Work Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
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Parent/Guardian #2
Name
First Name
Last Name
Work Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
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Enrollment Details
Desired Placement For Your Child
*
Infant (6 weeks - 12 months)
Young Toddler (Must be 1 by September 1)
Toddler (Must be 2 by September 1)
Preschool (Must be 3 by September 1)
Pre-K (Must be 4 by September 1)
Desired Time
*
Full Day (8:00 - 3:00) (Preschool and Pre-K Only)
Extended Day (8:00 - 6:00) (Infants, Toddlers, Preschool, and Pre-K)
Enrollment Preference
*
As soon as space is available
Request specific date
Does your child currently receive subsidized childcare funding (such as CCW or ACCM)?
*
Yes
No
Are you interested in participating in the Pre-K Counts Program? (Students must be 3 by September 1).
*
Yes
No
If interested in enrolling in the Preschool or Pre-K department, is your child fully potty trained
*
Yes
No
Are you interested in applying for tuition scholarships?
*
Yes
No
Does your child receive any developmental support services (such as speech therapy, behavioral, physical therapy, etc.)?
*
Yes
No
If you answered yes, which?
Has your child previously been enrolled in school?
*
Yes
No
If you answered yes, where? How long?
If you answered yes, please share your reason for leaving.
Name of any siblings or parents (if any) who are attending or have attended Shady Lane School:
How did you hear about Shady Lane School?
Friend
Shady Lane Website
Social Media
NAEYC Website
Other
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Schedule Your Tour
Tour Time Slot
*
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Payment
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( X )
Fee
$
25.00
Pay with PayPal
Choose from one of the PayPal options to
make your payment.
Submit
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