Milestone Manor's Registration Form 2026-2027

Milestone Manor WAITLIST Registration Form

2026-2027 School Year
Student Information
Full Time or Part Time*

Monday - Friday (Full Time)Tuesdays and Thursdays (Part Time)
Student Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Age*
2025-2026 Grade Level*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you considering before school care? (8:00am - 9:00am)

YesNo
Are you considering after school care? (3:00pm-4:30pm)

YesNo
Has the student ever been homeschooled?*

YesNo
If yes, please list program/curriculum
Does the applicant have any siblings that will be applying to Milestone Manor?

YesNo
Parent/Guardian Information
Parent/Guardian's Name - Primary*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Work Phone Number (if applicable)
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian's Name - Secondary*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Work Phone Number (if applicable)
Please enter a valid phone number.
Email*
example@example.com
How did you hear about us?*
Please list any other topics or questions you want to be addressed during the interview process.*
By submitting this form below, you certify the information in the inquiry form is true, accurate, and secure. By signing, you agree to share this information with Milestone Manor.

Milestone Manor is a Religiously Exempt Child Day Center (RECDC) by the Department of Education.
Date*

MonthDayYear
Date
Should be Empty:

Milestone Manor WAITLIST Registration Form

Student Information

Parent/Guardian Information