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Stepping Stone Children's Center

 

APPLICATION FOR ENROLLMENT OF NEW STUDENTS

School Year:    20

    Identification and Emergency Information

    Name of Child:                    Date of Birth:    //
    Street Address:  
    City:                   
    Zip code:                                                                                     Home Phone:       --

    Mother or Guardian:             (Maiden name):    
    Employer:                        Work Phone:       --    Ext.
    E-mail address:                Cell Phone:          --  

    Father or Guardian:        
    Employer:                        Work Phone:       --    Ext.
                                                                                                                    Cell Phone:          --  

    If either parent or guardian is a student, please list name of school, school phone number, and current schedule.

    School:                            Phone:                 -- 

    Schedule:               
                                 
                                   
                                 
                                 
                                 

    List persons authorized to pick up your child:   
(UNDER NO CIRCUMSTANCES WILL YOUR CHILD BE RELEASED TO ANYONE NOT KNOWN TO THE SCHOOL WITHOUT AUTHORIZATION FROM PARENTS OR GUARDIAN)

    Name:                   Relationship Parent/Guardian:   
    Name:                   Relationship Parent/Guardian:   
    Name:                   Relationship Parent/Guardian:   

    I will bring my child about                                 I will pick up my child about 

    I will bring my child on these days (Select all that apply):   

    Date you would like to start:    //    OR      Not Sure

    A registration fee of $55.00 must accompany this application. 

    If you e-mail the application, please understand that we cannot hold a spot for you until the registration fee is paid.

Or, you can simply print the form and drop it by the center with payment at your earliest convenience.