Student Application Form-Cumming Student Application Form-Cumming2022-23 Fees with DepositProgram applying for:*Infant 8:00 – 11:30Infant 8:00 – 3:00Infant 8:00 – 6:00Toddler 8:00 – 11:30Toddler 8:00 – 3:00Toddler 8:00 – 6:00Primary 8:00 – 11:30Primary 8:00 – 3:00Primary 8:00 – 6:00Before School: 7:00 – 8:00*YesNoPreferred Start date* Date Format: MM slash DD slash YYYY Student InformationChild’s Name* Child’s First Name Child’s Last Name NicknameGender*Birth Date* Date Format: MM slash DD slash YYYY Age*Home Address* Street Address City State / Province / Region ZIP / Postal Code Parent InformationParent #1 Name* Parent #1 First Name Parent #1 Last Name Phone*Parent Email* Address* Same as chilld's address Street Address City State / Province / Region ZIP / Postal Code Employer*Employer Phone*Employer Address*Parent #2 Name* Parent #1 First Name Parent #1 Last Name Phone*Parent Email* Address* Same as chilld's address Street Address City State / Province / Region ZIP / Postal Code Employer*Employer Phone*Employer Address*Lives with:*Both parentsMomDadDoes your child have any diagnosed special needs or medical conditions?*YesNoIf yes, please describe and attach care planAttach care plan Drop files here or Are your child’s activities restricted by any special needs, medical conditions or otherwise?*YesNoIf yes, please describe and attach care planAttach care plan Drop files here or Application Fee Price: $200.00 Parent Signature*Date* Date Format: MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
