Section 1

Child's Full Name*
(First Name Middle Initial Last Name)

Preferred Name

Date of Birth*

Sex*
FemaleMale

Additional Information*
Currently EnrolledSibling Enrolled or AlumniNew Student

Section 2

Name of Parent/Guardian*

Full Address*

Phone Number*

Email Address*

Preferred Contact Method*
PhoneEmail

Section 3 (Optional)

Name of Second Parent/Guardian

Full Address

Phone Number

Email Address

Preferred Contact Method
PhoneEmailNone

Section 4

Program Selection

Please select a program*
(2) Days, $400 per month(3) Days, $565 per month(4) Days, $735 per month

Based on your selection above, please select your preferred days*
Note: Since Tuesdays are extended days, 2 Day and 3 Day Programs will have a $45 additional fee per month if selected
Tuesdays (9:15 am - 2:30 pm)Wednesdays (9:15 am - 1:15 pm)Thursdays (9:15 am - 1:15 pm)Fridays (9:15 am - 1:15 pm)

Section 5

Child Interests and Experiences

Please tell us about your child. (Likes, interests, activities, etc.)*

What experiences has your child had with nature?*

What experiences has your child had in any other preschool or childcare environment?*

What do you hope your child will gain from a nature-based preschool?*

Would you be interested in an extended day option where school extends to 3PM?*