The Wonder Years Academy

The Wonder Years Academy

Enrollment Form
Please note that the sole purpose of this form is to enroll your child. A request for information or to schedule a tour may be done either by phone or through our website.
- Child's Name
  
  First NameMiddle NameLast Name
- Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Home Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Gender
- Enrollment Date (Expected Start Date)
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Attendance Days
- Will your child participate in the lunch program ?
- Name
  
  First NameLast Name
- Email Address
  example@example.com
- Relationship
  Mother, Father, etc
- Mobile Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Employer Name, Address, and Phone Number
- Name
  
  First NameLast Name
- Email Address
  example@example.com
- Relationship
  Mother, Father, etc.
- Mobile Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Employer Name, Address and Phone Number
- In the event of a medical emergency AND The Wonder Years Academy is unable to contact either parent, I hereby give permission for my child to receive medical treatment by emergency rescue squad paramedics if necessary, and/or other duly qualified medical personnel. Initials
- If The Wonder Years Academy is unable to reach either parent by phone, the following individuals are authorized to take my child from school and are to assume responsibility for my child in the event of an emergency. Initials
- Emergency Contact 1
  
  First NameLast NameRelationship
- Home Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Mobile Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Emergency Contact 2
  
  First NameLast NameRelationship
- Home Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Mobile Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Emergency Contact 3
  
  First NameLast NameRelationship
- Home Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Mobile Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Pediatrician's Information:
- Pediatrician's Name and Name of Practice (if applicable)
  
  Physician NameName of Practice
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- I have received and read the following policies: 1) Information to Parents Statement Initials
- 2) The Wonder Years Academy Expulsion Policy Initials
- 3) The Wonder Years Academy Discipline Policy Initials
- 4) The Wonder Years Academy Policy on the Use of Technology and Social Media, Initials
- 5) Communicable Diseases Initials
- 6) The Wonder Years Academy Child Release Policy Initials

The Wonder Years Academy

Pediatrician's Information: