Application for Enrollment

Child Info

Child's First Name*

Child's Last Name*

Child's Date of Birth*

Gender*MaleFemale

Parent/Guardian Info

Parent/Guardian First Name*

Parent/Guardian Last Name*

Address*

City*

State*

ZIP*

Phone Number*

Email Address*

Occupation*

Employer*

Secondary Parent/Guardian Info

Parent/Guardian First Name

Parent/Guardian Last Name

Address

City

State

ZIP

Phone Number

Email Address

Occupation

Employer

Additional Info

How did you hear about St. Michael’s School & Nursery?

Reason for placing child in our school

Has the child previously attended school or childcare?

Date you would like your child to start*

History

I hereby give permission for

Name of School or Childcare Provider

to release all school records, medical and developmental (including test scores) to St. Michael’s School & Nursery for the purpose of admission.

Further, I give permission for you to release all information about the status of my financial account while I was using your services.

Name of Child

Date child attended your program

School or Childcare Provider

Name of School/Childcare Provider