Universal Early Learning Center Student Enrollment Form

Universal Early Learning Center

1415 Catharine Street * Philadelphia PA, 19146 * 215-732-6518 * uelc@universalcompanies.org
Preschool Student Enrollment Form

Please fill out this form to enroll your child in our preschool program.
Child's Full Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Child's Gender*

MaleFemaleOther
Start Date*

MonthDayYear
Date
Parent/Guardian Full Name*

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Name*
Second Emergency Contact Name*

First NameLast Name
Second Emergency Contact Phone Number*
Please enter a valid phone number.
Health Conditions or Allergies (check all that apply)

NoneAsthmaAllergies to foodAllergies to medicationOther
Additional Information or Special Needs
Do you have subsidy?

YesNo
I agree to the preschool enrollment policies and terms.*
Should be Empty:

Universal Early Learning Center