The Wonder Years Academy

The Wonder Years Academy

Enrollment Form

Child's Information
Child's Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Home Phone
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender

FemaleMale
Enrollment Date (Expected Start Date)

MonthDayYear
Date
Attendance Days*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Will your child participate in the lunch program ?

Patents/Guardian & Emergency Contact Information
Name*

First NameLast Name
Email Address
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 childDifferent 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.
Work Phone Number
Please enter a valid phone number.
Address

Same with the childDifferent 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.
Mobile Phone Number
Please enter a valid phone number.
Emergency Contact 2

First NameLast NameRelationship
Home Phone Number
Please enter a valid phone number.
Mobile Phone Number
Please enter a valid phone number.
Emergency Contact 3

First NameLast NameRelationship
Home Phone Number
Please enter a valid phone number.
Mobile Phone Number
Please enter a valid phone number.
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.
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: