application for enrollment-1
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DESCRIPTION
Application for Enrollment-1TRANSCRIPT
SonShine Early Childhood Center
- Growing in the Light of Christs love
2418 Aurelius Rd. Holt, MI 48842
(517)694-3182 [email protected]
Application for Enrollment
First consideration for all ECC applicants will be given to full time contracts. Full time is defined as five full days of care. All others will be considered after that point.
Childs Name Date of Application _
Date of Birth Age Sex _
Present Address: _
Street City Zip
__
Name of Father/ Guardian _
Present Address: _
Street City Zip
Home Phone _________ C Cell Phone________________________ _
Email Address:_________________________________________ _
Name of Mother/ Guardian _
Present Address: _
Street City Zip
Home Phone _________ C Cell Phone________________________ _
Email Address:_________________________________________ _
Marital Status: Married _______ Divorced _______ Single _______ Remarried _______
How did you hear about our program? _______________________________________________________________________
_______________________________________________________________________
Program Applying For:
Preschool classes:
Preschool 3 Program T & Th, 8:00-11:00am Preschool 4 Program M,W,F 8:00-11:00am
Full Time Childcare
Infant Care (6 weeks 15 months)Toddler Care (15 months 36 months)3 year-old childcare4 year-old childcare
Part Time Childcare
Infant Care (6 weeks 15 months)Toddler Care (15 months 36 months)3 year-old childcare4 year-old childcare
Please specify days/times needed: _______________________________________________
Desired start date: _________________________
General Health:
I state that my child is
free from health conditions which could pose a risk to other children and adults.has no limitations or special needshas a health or handicapping condition, which could pose a risk to my child in care. I have attached a statement indicating the limits of participation and any special needs or treatment while in care.
My child has completed or is in progress of receiving immunizations and boosters as recommended by the Department of Community Health.
YES NO If NO, specify reason Religion
Other (please explain) _
_
School/Center Experience:
My child has previously attended another childcare center, home-based childcare or preschool.
YES NO
My child is in appropriate standing for enrollment (has not been suspended, expelled or removed from any childcare center, home-based childcare or preschool).
YES NO
_
Parents/Guardians SignatureDate
_
Parents/Guardians Signature Date