New Child Enrollment Form

We are: *
Child's Name *
Child's Name
Please complete a separate form for each child
Child's Date of Birth *
Child's Date of Birth
Does your child have any allergies? *
If YES, please list all allergies below.
Parent / Guardian Information
Parent / Guardian Name *
Parent / Guardian Name
Parent / Guardian Phone *
Parent / Guardian Phone
Additional Parent / Guardian Name
Additional Parent / Guardian Name
Additional Parent / Guardian Phone
Additional Parent / Guardian Phone
Emergency Contact Name *
Emergency Contact Name
Please list an emergency contact that is different from parents/guardians listed above. In an emergency situation, we will contact the two individuals listed above before contacting this emergency contact.
Emergency Contact Phone *
Emergency Contact Phone