Kindergarten Enrollment Application Question Title * 1. Parent/Guardian Name (Required.) Question Title * 2. Parent/Guardian Email (Required.) Question Title * 3. Parent/Guardian Telephone Number (Required.) Question Title * 4. Home Address (Required.) Question Title * 5. Child's Name (Required.) Question Title * 6. Child's Date of Birth (Required.) Date of Birth Date Question Title * 7. Child's Age Group (Required.) Kindergarten (5 years old on or before September 1st) Question Title * 8. Preferred Enrollment Schedule (Required.) School Hours (8:00am - 2:00pm) Before and/or After-school Care Needed Question Title * 9. How will school be paid for ? (Required.) Private Pay Subsidy (ELRC, CCAMPIS, DHS) plus Private Pay of the Difference Question Title * 10. Which location are you looking to enroll your child? (Required.) Location 2: 5828 Torresdale Avenue, Philadelphia, PA 19135 (Wissinoming) Question Title * 11. Does your child have any allergies? (Required.) Yes No Question Title * 12. If yes, please specify the allergies (Required.) Question Title * 13. Does your child have any special needs? (Required.) Yes No Question Title * 14. If yes, please specify the special needs (Required.) Question Title * 15. Any additional information we should know about your child? (Required.) Question Title * 16. When would you like your child to start? (Required.) Date Date Question Title * 17. Do you have any more children you would like to enroll for kindergarten? (Required.) Yes No Question Title * 18. Child's Name Question Title * 19. Child's Date of Birth Date of Birth Date Done
