Carol's With Care Learning Academy Enrollment Application

Carol's With Care Learning Academy Enrollment Application

"Where fun and learning go hand in hand"
Child's Name*

First NameLast Name
If enrolling more than one child please include their first and last names here:
Parents Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Parents name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Date of Birth*

MonthDayYear
If enrolling more than one child please add additional birthdates here:
How did you hear about Carol's With Care Learning Academy?*
Is this your child's first time in preschool or attending a childcare center?*

YesNo
If not, name(s) of previous centers and reason for leaving.
Does your child have any food allergies?*

YesNo
If yes, please explain.
Is your child potty trained?*

YesNo
Does your child take any medications prescribed by the doctor?
No medications will be dispensed by Carol's With Care Learning Academy, or it's employees unless a note is attached from the doctor's office stating that the child must take medication during the time of care. All medication to be given to the child must be in a pharmacy container with their name on it, the correct dosage, and how to dispense it. We will never give the first dosage.

Immunizations

After submitting the application please schedule an appointment to pick up the forms for physical and immunization. Must be completed within 2 weeks of enrollment.

Carol's With Care Learning Academy is regulated by the Oakland County Health Department. If your child is exempt from immunizations, please send a note from your pediatrician or health department.
Feel free to contact Ms. Carol at: (248) 416-6171 or carolswithcareacademy123@gmail.com to schedule your appointment.

Carol's With Care Learning Academy Enrollment Application

Application Payment