Fillable School Application 2021 Fillable

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School Application 2021 Fillable

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The School Application 2021 Fillable form is 2 pages long and contains:

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  • 10 check-boxes
  • 69 other fields

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File type: PDF

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Children’s Country Day School
1588 South Victoria Road Mendota Heights MN 55118
FOR OFFICE USE ONLY:
Continuing Student:
New Student:
Reg. Ck. #:
Amount:
Check Date:
PHONE: 651-454-4000 FAX: 651-454-7499 WEB: www.childrenscountryday.org
Desired Starting Date:
CHILD’S NAME:
(This is the name by which we will address your child and label their belongings.)
ADDRESS:
(Street)
(City)
(State)
(Zip Code)
BIRTH DATE:
AGE AS OF SEPT. 1:
/
GENDER:
M:
F:
(Years)
(Months)
PARENT/GUARDIAN #1:
HOME PHONE:
EMAIL ADDRESS:
PARENT/GUARDIAN’S EMPLOYER:
WORK PHONE:
CELL PHONE:
PARENT/GUARDIAN #2:
HOME PHONE:
EMAIL ADDRESS:
PARENT/GUARDIAN’S EMPLOYER:
WORK PHONE:
CELL PHONE:
ALLERGIES (please specify):
DIETARY RESTRICTIONS:
PROGRAMMING: Please check one item in each line in your child’s age bracket or desired program.
*Once your application has been submitted, any alterations or changes you make will be subject to availability and a $50.00 administrative fee.
TODDLERS: (All Toddler children MUST be walking independently)
A.M. only:
FULL DAY:
OTHER:
5 DAYS:
4 DAYS:
3 DAYS:
IF 3 OR 4 DAYS, PLEASE SPECIFY:
PRESCHOOL: (All Preschool II. children MUST be toilet-trained)
A.M. only:
FULL DAY:
OTHER:
5 DAYS:
4 DAYS:
3 DAYS:
IF 3 OR 4 DAYS, PLEASE SPECIFY:
Signature of Parent(s)/Legal Guardian(s):
DATE:
DATE:
*Please note: This form must be signed by both parents/guardians (whenever applicable).
(PLEASE COMPLETE THE REVERSE SIDE OF THIS FORM)
click to sign
signature
click to edit
For office use only:
-Confirmation letter sent
-Contract emailed
-Allergies/Care Plans sent (if needed)
-Open House letter sent (late enrollees)
September Tuition Payments:
Payment #1:
Payment #2:
Payment #3:
Ck.#:
Ck.#:
Ck.#:
Amt.:
Amt.:
Amt.:
Date:
Date:
Date:
Please list three people other than parents authorized to pick up your child at school or take responsibility for
your child if your child should become ill at school and you cannot be reached. Please list people who can be
reached during the day. Please note: Individuals authorized to pick up your child must live locally.
Name:
Relationship:
Address:
(Street)
(City)
(State)
(Zip Code)
Phone #:
Alternate Phone #:
Name:
Relationship:
Address:
(Street)
(City)
(State)
(Zip Code)
Phone #:
Alternate Phone #:
Name:
Relationship:
Address:
(Street)
(City)
(State)
(Zip Code)
Phone #:
Alternate Phone #:
Doctor to be called in case of emergency:
Address:
Phone #:
Dentist:
Address:
Phone #:
(*Note: This information is required for all children. If your child has no dentist, list a provider for a dental emergency.)
SIBLINGS BY AGE:
PREVIOUS GROUP OR SCHOOL EXPERIENCE:
IS YOUR CHILD TOILET-TRAINED?:
DOES YOUR CHILD REQUIRE A NAP?
DOES YOUR CHILD HAVE SPECIAL NEEDS OR RECEIVE SPECIAL SERVICES?
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School Application 2021 Fillable

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Completed 2 June 2021

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