Child Development Application Form: 2020-2021

Our Child Development Centers admit students of any race, color, national and ethnic origin to all the rights, privileges, programs & activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national & ethnic origin in administration of its educational policies, admissions policies, scholarship program, athletic & other school-administered programs.

Required at time of enrollment: Certified Birth Certificate (w/ raised seal) and immunization records (waiver must be official document and notarized).

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Would you like to add a child to this application?

No
Yes

Child #2

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Would you like to add a child to this application?

No
Yes

Child #3

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Would you like to add a child to this application?

No
Yes

Child #4

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Would you like to add a child to this application?

No
Yes

Child #5

Student's Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Student's Age

Date of Birth

Gender

Male
Female

Ethnicity

Hispanic
Non-Hispanic

Race

Please Specify

Grade Applying For

Previous School

Allergies?

Church you attend? Are you a member?

Apply For ChildCare

Step 1 of 4

Child Development Application Form: 2020-2021

Child #2

Child #3

Child #4

Child #5

Parent or Primary Care Giver Information #1

Parent or Primary Care Giver Information #2

Additional Contacts Permission Sheet

Ready to take the next step?

First Day of School

Home Volleyball Game vs Heartland Christian

Varsity Away Football Game vs St Edward

Home Jr High Football Game vs East Butler

SUBSCRIBE TO OUR NEWSLETTER

You have Successfully Subscribed!

M	T	W	T	F	S	S
« August 2020 »
					1	2
3	4	5	6	7	8	9
10	11	12	13	14	15	16
17	18	19	20	21	22	23
24	25	26	27	28	29	30
31