Registration Form

Child’s name:(Required)
Birthdate:(Required)
Gender:(Required)
Program:(Required)
Requested schedule:(Required)
Requested schedule Days: (check desired days)(Required)

Family Information

Student lives with (Check all that apply):(Required)
Parent/Guardian #1 Name:(Required)
Parent/Guardian #1 Address:(Required)
Parent/Guardian #2 Name:
Parent/Guardian #2 Address:(Required)

Siblings

Authorized People to Release Students to (not including parents):

General Information

Eats with:(Required)
Drinks from:(Required)

Scholastic Information

Potty trained:(Required)
Diaper/Pull-up at rest time:(Required)

Developmental History

Please check all that apply:(Required)

Authorization and Consent

Emergency Care

Date:(Required)

Photo Consent

During the course of daily learning experiences, pictures are taken to document and celebrate children’s accomplishments! We request your permission to include your child within the school and on My Learning Tree’s social media platforms and materials.(Required)

Sunscreen Application Consent

I want my child to have sunscreen applied prior to outdoor play. I will provide sunscreen for my child to use that is not expired, and is labeled.(Required)

Acknowledgement

By signing below, you hereby verify that all information on this application for enrollment is complete and accurate, and that you will abide by its policies herein.

Date:(Required)