Little Melodies Application Form

Little Melodies Application Form
Thank you for your interest in Little Melodies Early Learning & Childcare. We appreciate the care and thought families put into choosing an early learning environment, and we are honored to be considered. Our application process helps ensure that Little Melodies is a strong and intentional fit for both children and families.
Parent /Guardian 1 Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Child
Contact Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Full Name

First NameLast Name
Address (if different from Parent 1)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Child
Contact Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child's Full Name

First NameLast Name
Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Does your child have any allergies or medical conditions?
If yes, please describe allergies or medical conditions
Please note that schedules are subject to availability and are reserved upon enrollment.
Schedule Options (please select the schedule you are applying for)
Preferred drop-off time

Hour Minutes

AM/PM Option
Preferred pick-up time

Hour Minutes

AM/PM Option
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please share in a Family Statement what you are looking for in an early learning program and why Little Melodies feels like a good fit for your family.
Family Statement
Waitlist Acknowledgement

Enrollment is offered based on availability and program fit.
- I understand that placement on the waitlist does not guarantee enrollment or a specific start date.
- I understand that if a space is not currently available, my child may be placed on a waitlist.
Waitlist Acknowledgement Initials
Tuition & Program Acknowledgement

Please initial to acknowledge the following:
- I understand that tuition rates and schedules will be provided prior to enrollment.
- I understand that tuition is due regardless of attendance, including absences, holidays, or closures as outlined in the parent handbook.
- I understand that submission of this application does not guarantee enrollment.
Tuition & Program Acknowledgement Initials
Tour Policy Acknowledgement

I understand that a completed application must be recieved before a tour can be scheduled.
Tour Policy Acknowledgement Initials
SIGNATURE

By signing below, I confirm that the information provided is accurate and that I understand and agree to the poicies outlined above.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty: