Child Intake Information Child's Name * Child's Name First Name Last Name Child's Date of Birth * Child's MM DD YYYY Sex * Male Female Parent Intake Information 1 Parent/Guardian Name * Parent/Guardian First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Parent Intake Information 2 Parent/Guardian Name Parent/Guardian First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Employment History Employer's Name * First Name Last Name Employer's Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Child's Schedule Days * Monday Tuesday Wednesday Thursday Friday Duration * - Half Day Full Day Thank you! Someone from administration will contact you within 24 hours :-) Please schedule an meeting with the school to filalize your childs enrolment in our program