Somos Early Learning Enrollment Form
Child's Information
Child's Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Home Phone
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
Female
Male
Attendance Information
Expected Start Date
*
-
Month
-
Day
Year
Date
Are keeping your current Plan?
Yes
No
If you answer No in the previous question, please indicate here how are you upgrading your plan.
Add Before School
Add After shool
Add Before & After shool
Upgrade from Part-time to Full-time.
Other ( I will inform in person)
Additional Information regarding Attendance
Patents/Guardian 1 & Emergency Contact Information Update
Please indicate here if there are any changes to your contact information.
*
Yes
No
If you answer yes to the previous question, please complete the information below.
Indicate here what information you are upgrading.
Name
First Name
Last Name
Email
example@example.com
Relationship
Mother, Father, etc
Mobile Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Address
Same with the child
Different Address
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Patents/Guardian 2 & Emergency Contact Information Update
Name
First Name
Last Name
Email
example@example.com
Relationship
Mother, Father, etc.
Mobile Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Address
Same with the child
Different Address
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How would you like to pay for your for your required four weeks deposit?
*
Apply the current (2023-24) deposit toward the next school year's (2024-25) deposit.
Brightwheel Invoice
Check
Do you want to add something?
Marital status of parents, medical information, people who the child cannot be released, etc
Submit
Should be Empty: