Enrollment Application and AgreementEnrollment Application and Agreement • December 25th, 2022
Application: Complete one application for each child. Please print throughout, except where a signature is required. Note that we only provide care to children ages 2 ½ - 5, on a full-time basis, Monday through Friday throughout the year. We do not provide before- or after-school care for other children. Your need for care must fall within those parameters.
Enrollment Application and AgreementEnrollment Application and Agreement • September 20th, 2019
Mother or Legal Guardian Father or Legal Guardian Street Address Street Address City/State/Zip City/State/Zip Home Phone Cell Phone Home Phone Cell Phone Employer Employer Employer Address Employer Address Employer Phone Ext. Employer Phone Ext. Primary Email Address Primary Email Address
Hancock Community Education Foundation Wednesday Daycare Enrollment Application and Agreement You must attend the after-school program to be able to attend on Wednesdays. This form must be complete before your child can attend!Enrollment Application and Agreement • September 3rd, 2020
Health – Any health or special situations concerning the child of which the director and assistants need to be aware, such as allergies, existing / pre-existing illnesses, injuries, disabilities or any medications prescribed for long term use:
ContractEnrollment Application and Agreement • April 13th, 2020
Applicant Information Type or clearly print requested information. You must complete all spaces on this page.Return to MBA USA, Inc. with required deposit and/or funding information. Name First Middle Last Address Street City State Zip Code Contact Phone number Email address Personal Info. Sex Date of birth Place of Birth Yes o No oUS Citizen? Yes o No oEver convicted of a felony? Years of high school or college completed Employment and References If you are self employed, please include your company name. Current Employer Company Name Phone Dates of employment Street Address City State Zip Code Previous Employer Company Name Phone Dates of employment Street Address City State Zip Code CharacterReference Name of Character Reference (no family members) Phone Street Address City State Zip Code Course Information
1stChild Date of Birth Male_ Female_Enrollment Application and Agreement • August 12th, 2015
Full Address _ Home Phone Alternate Phone Date attendance will begin e-mail address Normal attendance will be approximately a.m. to p.m. on the following days:
Enrollment Application and AgreementEnrollment Application and Agreement • January 10th, 2023
Mother or Legal Guardian Father or Legal Guardian Street Address Street Address City/State/Zip City/State/Zip Home Phone Cell Phone Home Phone Cell Phone Employer Employer Employer Address Employer Address Employer Phone Ext. Employer Phone Ext. Primary Email Address Primary Email Address
Hancock Community Education Foundation After School Program Enrollment Application and Agreement This form must be complete before your child can attend the After School ProgramEnrollment Application and Agreement • September 2nd, 2022
My child, ________________________________________, will be staying after school on the following days for the After School Program: Monday ____ Tuesday ____ Wednesday_____Thursday ____ Friday ____
ContractEnrollment Application and Agreement • July 26th, 2013
Last, First, M.I. Sex: M / F Date of Birth: Age: Address: City: State: Zip Code: Has your child been previously enrolled in a preschool, child care or group play program? Y N Is your child toilet trained? _Y N In progress Does your child speak another language? Y N Specify
ENROLLMENT APPLICATION AND AGREEMENTEnrollment Application and Agreement • September 15th, 2017
Last Name First Name Social Security No. Date of Birth H.S. Diploma or GED Address City State and Zip Code Home Phone Cell Phone Email Address
RETURNING STUDENT ENROLLMENT CHECKLISTEnrollment Application and Agreement • February 25th, 2019
By signing this Enrollment Contract, effective as of the dated set forth below, I/We, (“Parents or Guardians”), the parents or legally appointed Guardian of (“Student”), agree to the following terms and conditions for enrollment of Student in the Creo School Toddler, Children’s House, and/or Elementary Program.
THE VILLAGE CHILD DEVELOPMENT CENTER #1, INC. ENROLLMENT APPLICATION AND AGREEMENTEnrollment Application and Agreement • March 14th, 2014
Full day (6:30 am – 6:30 pm) 11 hours max Full day (6:30 am – 6:30 pm) 11 hours max Private Kindergarten Private Kindergarten Before & After School * Before & After School * Other Other Days:Mon Tues Wed Thurs Fri Days:Mon Tues Wed Thurs Fri *If your child is attending our Before & After School Program, please complete the information below: School: Grade(s): Drop-Off: a.m. Pick-up: p.m. MOTHER or Guardian: Home Phone: Home Address: Employer: Work Phone: Employer Address: Occupation: Mobile Phone: Email FATHER or Guardian: Home Phone: Home Address: Employer: Work Phone: Employer Address: Occupation: Mobile Phone: Email: STATUS OF CHILD’S PARENTS: Married: Separated: Divorced: Other:
ContractEnrollment Application and Agreement • March 4th, 2014
OTHER PERSONS TO WHOM BROADWAY & C-470, LLC dba HIGHLANDS RANCH LEARNING CENTER(“CENTER”) IS AUTHORIZED TO RELEASE A CHILD: Under no circumstances will Center release a child to anyone not identified below or not otherwise known to staff without specific written authorization from the parent or guardian. Additions or changes to the list of persons appearing below will be made on the Emergency Card. Any such authorized persons may be required to present identification. Name: Relationship: Address: Phone: Mobile Phone: Name: Relationship: Address: Phone: Mobile Phone:
Summer L*E*A*P Enrollment Application and AgreementEnrollment Application and Agreement • February 19th, 2019
ENROLLMENT APPLICATION AND AGREEMENTEnrollment Application and Agreement • December 20th, 2021
MY CHILD IS CURRENTLY ON MEDICATION( S) PRESCRIBED FOR LONG TERM CONTINUOUS USE AND/ OR HAS THE FOLLOW ING PRE- EXISTING ILLNESS, HEALTH CONDITONS, MENTAL CONCERNS OR DIETARY RESTRICTIONS:
Enrollment Application and AgreementEnrollment Application and Agreement • December 31st, 2019
By completing and submitting this information, you will apply for membership in VNSNY CHOICE Managed Long Term Care an� agree to plan policies. Questions filling out the form? Please call Member Services at 1-855-867-6555 (TTY: 711) 9 am - 5 pm, Monday - Friday.
Enrollment Application and AgreementEnrollment Application and Agreement • November 30th, 2017
Mother’s Full Name Address City Zip Home Phone # Cell Phone # Work Phone # E-mail address Occupation Name of Employer Business Address Work Hours Driver’s License # Social Security #
ENROLEMENT APPLICATION AND AGREEMENT Entered into betweenMADELEINE LUDSKI obo LADYBUG DAYCARE (PTY) LTD(hereafter referred to as “the School”)And 1. THE PARENT(S) / LEGAL GUARDIANS A. Mother / Legal Guardian Details *Please furnish a copy of both...Enrollment Application and Agreement • September 17th, 2014
ENROLLMENT APPLICATION AND AGREEMENTEnrollment Application and Agreement • March 31st, 2023
Status of Parents: (select one) Married Separated Divorced Other With whom does child live? Are there any limitations on either parent's right to pick up or visit this child at the school? No Yes (If 'Yes', please attach a copy of the court order to keep on file at White Oak Learning Academy)
1stChild Date of Birth Male_ Female_Enrollment Application and Agreement • May 14th, 2020
Full Address _ Home Phone Alternate Phone Date attendance will begin e-mail address Normal attendance will be approximately a.m. to p.m. on the following days:
Enrollment Application and AgreementEnrollment Application and Agreement • December 19th, 2015
* If the child does not live with both parents, a copy of the court ordered custody decree must be maintained in the child's permanent school file. The guidelines of the custody decree will be strictly enforced.
