Name (Person completing this form) *

First Name

Last Name

What classes are you interested in? *

EL 1 (15months-2 years)

EL 2 (2-3 years)

Pre-Kindergarten (3-4 years)

Kindergarten (Junior Kindergarten 4-5 years; Kindergarten 5-6 years)

Which days are you looking to enrol? *

Monday

Tuesday

Wednesday

Thursday

Friday

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent 1 Contact *

First Name

Last Name

Parent 2 Contact

First Name

Last Name

Sibling 1 Name

First Name

Last Name

Sibling 1 D.O.B

MM

DD

YYYY

Sibling 2 Name

First Name

Last Name

Sibling 2 D.O.B

MM

DD

YYYY

Sibling 3 Name

First Name

Last Name

Sibling 3 D.O.B

MM

DD

YYYY

Pembantu / Nanny Name

First Name

Last Name

Has your child had all of their age appropriate vaccinations? *

Yes

No

Does your child have any medical disabilities or special educational needs? *

Yes

No

Does your child have any medical problems or allergies? *

Yes

No

Are there any food allergies that your child has? *

Yes

No

Does your child require an Epipen?

Yes

No