Application for EnrollmentCGAdmin2018-09-06T23:04:01-04:00 Child's Name:*Gender:*Date of birth:* Proposed Date of Entrance:*I am applying for:Full Day Selection Monday Full Day - 8am-4:30pm Tuesday Full Day - 8am-4:30pm Wednesday Full Day - 8am-4:30pm Thursday Full Day - 8am-4:30pm Half Day Selection Monday Half Day - 8am-12:30pm Tuesday Half Day - 8am-12:30pm Wednesday Half Day - 8am-12:30pm Thursday Half Day - 8:00am-12:30pm FAMILY INFORMATION Parent 1:*Address:*Please provide your full street address, state and postal codeHome Phone:Cell Phone:*Email:* Employer:*Position:*Work Address:*Work Phone:* Parent 2:*Address:*Please provide your full street address, state and postal codeHome Phone:Cell Phone:*Email:* Employer:*Position:*Work Address:*Work Phone:* Child lives with (Please check all that apply)* Mother/s Father/s Partner Stepmother Stepfather Parents Separated Parents Divorced Mother Deceased Father Deceased Specify custody arrangements, if any:If two households, mailings should be sent to:Parent 1Parent 2 Please list the names and ages of other members of the household:Name:Date of Birth Relationship to child:Name:Date of Birth Relationship to child:PetsHas your child been weaned?*YesNoComments:Has your child been toilet trained?*YesNoComments:Please describe your child’s experience outside the home (babysitter, playgroup, playmates, grandparents):*How often does your child watch TV or videos? Use the computer/tablet/iPad?*Are there special considerations you have for your child of which we should be aware? (extra-ordinary events, medical, movement, behavioral or emotional concerns)*Is your child taking any regularly scheduled medications? Please specify. (Send records where applicable.)*Has your child ever had any sensory, movement or REACH evaluations or any educational or psychological testing?*YesNoIf yes, please describe and attach copies of the reportIf yes, please describe and attach copies of the reportDoes your child have any allergies?*Comments: Is there anything you would like use to know about your child?Please tell us how you heard of our program?*Word of MouthFriendOther SchoolWebsiteOtherA non-refundable application fee of $25 must accompany this application. The fee can be paid by Credit Card or PayPal using the button at the bottom of this page. We will then call you to set up an appointment. The Cottage Garden does not discriminate on the basis of race, color, religion, sexual orientation, or national origin in its admissions or educational policies Parent 1 Signature:*Date:* Parent 2 Signature:*Date:* Application Received on:Application Fee Received on:Interview 1 scheduled for:Interview 2 scheduled for: CAPTCHA
