Shady Lane ROI Form

Registration of Interest in Placement at Shady Lane School

I am interested in enrolling my child in the Shady Lane School five-day program. I understand that I must pay $25 to register this intent. I understand the fee is waived if I qualify for subsidized childcare funding.
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Date
Child's Sex*

MaleFemaleOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Registration of Interest in Placement at Shady Lane School