Children's Day School
"We give roots; we give wings"
Parent / Caregiver Information
Parent/Caregiver 1 Name:
Phone Number 1:
E-mail #1:
Address Parent 1
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Caregiver 2 Name:
E-mail #2:
Address Parent 2
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number Dad
Student Information
Student Name:
DOB/Due Date
Desired Enrollment Date:
Ex: 00/00/0000
Choose Location
Please Select
Select One
Riverside
Glenville
Either one
Preferred Schedule:
Select one
M-T-W-TH-F
M-W-F
T-TH
Will you apply for our Tuition Assistance Program?
Select one
Yes
No
Will you be receiving Care 4 Kids financial assistance?
Select one
Yes
No
Referred By:
Example: Current CDS Family (include Names), Family members, Website, Drive By
Any Additional Information about your child:
Your E-mail:
Email for receiving your form submission
RIVERSIDE:: Type in the first letter of each day that is needed:
Example (M, T, W, TH, F)
GLENVILLE: Type in the first letter of each day that is needed:
Example: (M, T, W, TH, F)
Flexible: Type in the first letter of each day that is needed:
Example (M, T, W, TH, F)
Anticipated Classroom:
Tour Date / Time
Call the school office for date and time
Financial Assistance / Care4Kids
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Submit
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