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Child's Name: | |
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M or F |
(circle one) |
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Date of Birth: | |
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Home Telephone: | |
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Street Address (Home): | |
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City/State/Zipcode: |
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Mother's Name: | |
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Address: | |
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Place of Employment: | |
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Work Telephone: | |
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Home Telephone: | |
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Father's Name: | |
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Address: | |
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Place of Employment: | |
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Work Telephone: | |
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Home Telephone: | |
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Does Your child have any special needs? Please explain: |
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Requested Enrollment Schedule: (Please indicate the first and second choice of the following options listed below.) |
Full Day Options
Hours: 7:30 a.m. - 5:30 p.m. (Infant and Toddler Programs)
8:00 a.m. - 3:30 p.m. (Preschool and School Age Programs) |
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5 days per week | |
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3 days per week (M,W,F) | |
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2 days per week (T,Th) |
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Half Day Options (Not available during Summer on the Farm)
Hours: 8:15 a.m. - 11:30 a.m. or 12:30 p.m. - 3:45 p.m.
Not available for Infant and Toddler Programs |
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5 days per week | |
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3 days per week (M,W,F) | |
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2 days per week (T,Th) | |
Check One: |
My child will attend Kids Express Learning Center's half day option in the morning.
My child will attend Kids Express Learning Center's half day option in the afternoon.
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Extended Hours Options (Not applicable to Infant and Toddler Programs)
Please check all days when your child will attend:
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Before School
(7:30 a.m. - 8:00 a.m.) |
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There is an additional fee for Before School above and beyond the regular tuition fees. |
''Roots & Shoots'' After School Program
(3:30 p.m. - 5:30 p.m.) |
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There is an additional fee for After School above and beyond the regular tuition fees.
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My child's first day of school will be: |
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Kids Express Learning Center's School Year Begins on Thursday, September 2, 2010. |
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Please print and complete this enrollment application and mail to:
Dr. Sandra S. Dahl
Kids Express Learning Center
Prairie View Farm
3276 High Point Road
Madison, WI 53719
608.845.DAHL (3245)
A non-refundable processing fee is due with this form: $75
Upon receipt of this Enrollment Application and
fee, your child's name will be placed on our
potential enrollment list. Prior to your child's first
day of school, you will receive an enrollment
agreement to verify your child's acceptance and
schedule. Once the enrollment agreement is
signed and returned with a tuition deposit, a packet
of registration materials will be sent to your home
address.
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For Office Use Only
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Check Number:_________
Amount: $________ Date:___________ |
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Class:_____________________ Director:_____________________
Entered:__________ |
