Milestone Manor's Registration Form 2026-2027

Milestone Manor Registration Form

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

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Age
2026-2027 Grade Level
Address

Street Address

CityState / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you considering before school care? (8:00am - 9:00am)
Are you considering after school care? (3:00pm-4:30pm)
Has the student ever been homeschooled?
If yes, please list program/curriculum
Does the applicant have any siblings that will be applying to Milestone Manor?
Parent/Guardian Information
Parent/Guardian's Name - Primary

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Parent/Guardian's Name - Secondary

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
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 Registration Form

Student Information

Parent/Guardian Information