Date of Last Upload:
Thursday, March 5, 2026
Student Enrollment Form
New Student Information
Select the Submit Application tab after you have filled in all information including students, primary and secondary family, and emergency/contacts. Use the tab buttons to select the pages to fill in the information.
*
Required fields are bold.
Student's Information
Primary Family Information
Secondary Family Information
Contact Information
Submit Application
Student 1
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
*
Grade Level
<None>
Toddler (12/24 months)
2's class (2 by 9/1)
3s Class (3 by 9/1)
3 older class (4 by 12/31)
Pre-K (4 by 9/1)
K5
Pre-Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
*
Potty Trained
Prior Preschool Experience
Church Affiliation
<None>
Languages spoken at home
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Native American
E-Mail
Medical or Developmental Items
Medications List All
Dietary restrictions
Allergies List all
Reactions to Allergies
Fears List all
Number of days per week
Registration Type
<None>
2026 Preschool
2026 Summer Camp June 15-19
2026 Summer Camp June 22-26
Photo Release
Student 2
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
*
Grade Level
<None>
Toddler (12/24 months)
2's class (2 by 9/1)
3s Class (3 by 9/1)
3 older class (4 by 12/31)
Pre-K (4 by 9/1)
K5
Pre-Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
*
Potty Trained
Prior Preschool Experience
Church Affiliation
<None>
Languages spoken at home
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Native American
E-Mail
Medical or Developmental Items
Medications List All
Dietary restrictions
Allergies List all
Reactions to Allergies
Fears List all
Number of days per week
Registration Type
<None>
2026 Preschool
2026 Summer Camp June 15-19
2026 Summer Camp June 22-26
Photo Release
Student 3
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
*
Grade Level
<None>
Toddler (12/24 months)
2's class (2 by 9/1)
3s Class (3 by 9/1)
3 older class (4 by 12/31)
Pre-K (4 by 9/1)
K5
Pre-Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
*
Potty Trained
Prior Preschool Experience
Church Affiliation
<None>
Languages spoken at home
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Native American
E-Mail
Medical or Developmental Items
Medications List All
Dietary restrictions
Allergies List all
Reactions to Allergies
Fears List all
Number of days per week
Registration Type
<None>
2026 Preschool
2026 Summer Camp June 15-19
2026 Summer Camp June 22-26
Photo Release
Student 4
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
*
Grade Level
<None>
Toddler (12/24 months)
2's class (2 by 9/1)
3s Class (3 by 9/1)
3 older class (4 by 12/31)
Pre-K (4 by 9/1)
K5
Pre-Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
*
Potty Trained
Prior Preschool Experience
Church Affiliation
<None>
Languages spoken at home
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Native American
E-Mail
Medical or Developmental Items
Medications List All
Dietary restrictions
Allergies List all
Reactions to Allergies
Fears List all
Number of days per week
Registration Type
<None>
2026 Preschool
2026 Summer Camp June 15-19
2026 Summer Camp June 22-26
Photo Release
Student 5
*
Last Name
*
First Name
Middle Name
Preferred Name
Date of Birth
*
Grade Level
<None>
Toddler (12/24 months)
2's class (2 by 9/1)
3s Class (3 by 9/1)
3 older class (4 by 12/31)
Pre-K (4 by 9/1)
K5
Pre-Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
*
Potty Trained
Prior Preschool Experience
Church Affiliation
<None>
Languages spoken at home
Gender
<None>
Female
Male
Race
<None>
African American
Asian
Caucasian
Hispanic
Native American
E-Mail
Medical or Developmental Items
Medications List All
Dietary restrictions
Allergies List all
Reactions to Allergies
Fears List all
Number of days per week
Registration Type
<None>
2026 Preschool
2026 Summer Camp June 15-19
2026 Summer Camp June 22-26
Photo Release
Primary Family Information
Address Line 1
Address Line 2
City
State
ZIP Code
Home Phone
Home Listed
Cell Phone
Cell Listed
Parent 1 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Address Line 1 Parent 1
Address Line 2 Parent 1
City Parent 1
State Parent 1
Zip Code Parent 1
Is Allowed to Pickup
Church Affiliation
<None>
Race
<None>
African American
Asian
Caucasian
Hispanic
Native American
*
Home E-Mail
*
Cell Phone Parent 1
Does your child have siblings
Parent 2 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Address Line 1 Parent 1
Address Line 2 Parent 1
City Parent 1
State Parent 1
Zip Code Parent 1
Is Allowed to Pickup
Church Affiliation
<None>
Race
<None>
African American
Asian
Caucasian
Hispanic
Native American
*
Home E-Mail
*
Cell Phone Parent 1
Does your child have siblings
Secondary Family Information
Address Line 1
Address Line 2
City
State
ZIP Code
Home Phone
Home Listed
Cell Phone
Cell Listed
Parent 3 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Address Line 1 Parent 1
Address Line 2 Parent 1
City Parent 1
State Parent 1
Zip Code Parent 1
Is Allowed to Pickup
Church Affiliation
<None>
Race
<None>
African American
Asian
Caucasian
Hispanic
Native American
*
Home E-Mail
*
Cell Phone Parent 1
Does your child have siblings
Parent 4 Information
*
Last Name
*
First Name
Middle Name
Preferred Name
Address Line 1 Parent 1
Address Line 2 Parent 1
City Parent 1
State Parent 1
Zip Code Parent 1
Is Allowed to Pickup
Church Affiliation
<None>
Race
<None>
African American
Asian
Caucasian
Hispanic
Native American
*
Home E-Mail
*
Cell Phone Parent 1
Does your child have siblings
Contact Information (Other than parents)
Contact 1
*
Last Name
*
First Name
Relation
<None>
Aunt
Friend
Grandparent
Spouse
Brother
Father
Mother
Uncle
Sister
Is Emergency Contact
Home Phone
Is Allowed to Pickup
Business Phone
Pickup License
*
Cell Phone
Pickup Tag
Pickup Notes
Contact 2
*
Last Name
*
First Name
Relation
<None>
Aunt
Friend
Grandparent
Spouse
Brother
Father
Mother
Uncle
Sister
Is Emergency Contact
Home Phone
Is Allowed to Pickup
Business Phone
Pickup License
*
Cell Phone
Pickup Tag
Pickup Notes
Contact 3
*
Last Name
*
First Name
Relation
<None>
Aunt
Friend
Grandparent
Spouse
Brother
Father
Mother
Uncle
Sister
Is Emergency Contact
Home Phone
Is Allowed to Pickup
Business Phone
Pickup License
*
Cell Phone
Pickup Tag
Pickup Notes
Medical Contacts
Physician
Physician Phone Number
Insurance
Insurance Phone Number
Policy Number
Finished
Confirmation E-Mail address:
Please press the save button to submit the new student application.
