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Application Form

  • Student Information

  • At this time, we are not sure Early Care or After Care will be offered.  Please notate it if you would want it, should it be offered.

  • Parent Information

  • Supplemental Questions

  • Describe the relationship you would like to have with your child's teachers and the community.

  • Does your child have an IEP, 504 plan, or private neurospsychological or psycho-educational evaluation, and/or does your child currently receive any related service such as OT/PT, speech therapy, special education services or counseling?

  • Does your child have a medical condition that requires management, medication, and/or care at school (including allergies, asthma, diabetes, seizures, etc)?

  • What are your goals for your child in the upcoming year?

  • Is there anything else you would like us to know about your child?

  • Payment Information

  • Credit Card
    Billing Address
  • Agreement

  • By submitting this form and checking the box below, I hereby submit this application for my child.  I understand that the $175 per child Enrollment Fee is non refundable. 

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