Primrose School of Copley Pre-Registration Form

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MonthDayYear
Date
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First NameLast Name
Registration Type
Date of Registration

MonthDayYear
First Day of Attendance*

MonthDayYear
This is your request, and not a guaranteed start date. School Administrator will confirm the logistics back to you.
I hereby apply for enrollment of my child to Primrose School(s)
- Child's Current Grade
  If attending Primrose School
- Child's Name*
- Child's Nickname
- Address*
  
  Address
  
  Street Address Line 2
  
  CityState
  
  Zip
- Birth Date*
  
  MonthDayYear
  Date
- MaleFemale
- Age*

- Primary Sponsor*
  Name
- Relationship to Child*
  Father, Mother, Grand parent, ...
- Driver's License #*
- Housing Subdivision*
- YesNo
- Address*
  
  Address
  
  Street Address Line 2
  
  CityState
  
  Zip
- Home Phone*
  Format: (000) 000-0000.
- Cell Phone*
  Format: (000) 000-0000.
- YesNo
- Employer*
- Work Phone*
  Format: (000) 000-0000.
- Work Hours*
- Employer's Address*
- Primary Sponsor Email Address*
  example@example.com

- Secondary Sponsor
- Relationship to Child
- YesNo
- Address
  
  Address
  
  Street Address Line 2
  
  CityState
  
  Zip
- Driver's License #
- Home Phone
  Format: (000) 000-0000.
- Cell Phone
  Format: (000) 000-0000.
- Employer
- Work Hours
- Employer's Address
- Work Phone
  Format: (000) 000-0000.
- Secondary Sponsor Email Address
  example@example.com

- YesNo
- If yes, which year?
- YesNo
- If yes, give sibling's first name(s)
  Can separate multiple names by "," comma
- and age(s)
  Can separate multiple ages by "," comma

- Select a Program*
  * Check if program available at the location
- Select Number of Days*
  **Explorers 3 days or 2 days can come any days of their choice
- Registration Fee ($ USD)
  Only once a year
- Supply Fee ($ USD)
  Only once a year
- Weekly Fee ($ USD)
- Registration Fee Due Today ($ USD)
- Promo Code
- IMPORTANT NOTE: Primrose Schools reserves the right, at any time and in its sole discretion, to correct any billing errors or discrepancies, whether discovered prospectively or retroactively, and the undersigned agrees to remain fully responsible for all tuition and fees properly due, it being understood that any prior incorrect, omitted, or reduced billing shall not constitute a waiver, credit, or permanent benefit.
  
  ENROLLMENT: Prior to your child's attendance at Primrose, all the enrollment information must be completed, signed and returned to the school office along with your child's non-refundable registration/equipment fee.
  
  Please provide an email address where all the enrollment paperwork to be sent:
- Parent / Guardian Email
  example@example.com
- *The start month/year provided above is only TENTATIVE and NOT promised. Someone from our Leadership Team will contact you closer to the tentative start date.
- Signature of Parent/Guardian
  
  Clear
- Date*
  
  MonthDayYear
  Date
- For Office Use Only
- Office Password
  For Office Use Only. Please do not fill.
- Enrollment Counselor Notes
- Registration Fee Paid (Amount)
- Registration Fee Received By
- Projected Start Month/Year
- Administrator Name
  
  First NameLast Name
- Administrator Enrollment Notes
- Administrator Signature
  
  Clear
- Geolocation*
- School Email
  example@example.com
- NO REPLY
  example@example.com
- Should be Empty:

For Office Use Only