Child Intake Information

Child's Name

First Name

Last Name

Child's Date of Birth

Child's

YYYY

Sex

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

(###)

###

####

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

(###)

###

####

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

Please schedule an meeting with the school to filalize your childs enrolment in our program