ENROLLMENT APPLICATION Child's Name FirstLast Date of Birth01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Age GenderMaleFemale Has your child been to a Preschool before? If Yes, Where and for How long?Please check the appropriate program Schedule & Meal PatternFull Time 5 days a week Monthly $Select value$10$20$30$40$50$60$70$80$90$100 Weekly $Select valueoption 1option 2Part Time 3 days a week* Monthly $Part Time 3 daysSelect valueoption 1option 2 Weekly $Part Time 3 daysSelect valueoption 1option 2Part Time 2 days a week* Monthly $ Part Time 2 daysSelect valueoption 1option 2 Weekly $Part Time 2 daysSelect valueoption 1option 2 MatrixMonday TuesdayWednesdayThursday FridayBreakfastLunch Snack Hours of Care ( ex 9-5) Request starting date How did you hear about usPARENT / GUARDIAN INFORMATIONMother's Information Mother's Name Social Security # DL # Address City State Zip Email Home Phone Place of Employment Cell Phone Job Title Work PhoneFather's Information Father's Name Social Security #Father DL #Father AddressFather CityFather StateFather ZipFather EmailFather Home PhoneFather Place of EmploymentFather Cell PhoneFather Job TitleFather Work PhoneFather Custody Information Marital Status List any allergies your child has My child excels in My child needs help in Parent's evaluation of child's personality Does your child have any special needs/problems/fears? Additional information we should know about your childReturn this completed application with your enrollment fees as soon aspossible to reserve your child's space. Enrollment fees do not include yourfirst week's tuitionI understand I am signing up for specific days and times and I am responsible for Payment according to the school policyI understand that the enrollment fees are non-refundable. Date Parent/Guardian's SignatureClearKIDS ADVENTURE LEARNING CENTER1834 W. Valencia Dr.Fullerton, CA 92833Phone: 714-525-7377Fax: 714-525-3985Kids Adventure learning uses Remind, a text messaging/email service, to send outimportant reminders and/or safety alerts if ever needed. If you would like to be signed up forRemind text messages/emails please provide your name and preferred cell phone number andor email below. One or both Parents are wel9ome to sign up. This program is forPARENTS/GUARDIANS ONLY.Please be aware this is a one way form of communication, no responses to Remindmessages will be received by Kids Adventure Leaming. Please always call the center directlyor stop by the office if you have any questions or concerns. Child's Name: Classroom: Contact 1 Contact 1 Name Contact 1 Cell Phone # Email1Contact 2 Contact 2 Name Contact 2 Cell Phone # Email2SubmitReset
