Enrollment Application

Today’s Date:		Start Date:
Program Information:	Full Time:	Part Time:	Days:
Location:	Almaden LocationBerryessa Location
Child’s Information
Child’s Full Name:			DOB:
Address:
City:		State:	Zip:
Parent/Guardian 1		Parent/Guardian 2
Name:		Name:
Phone:		Phone:
Email:		Email:
Emergency Contact (non-guardian)
Name:		Relation to child:
Home phone:		Cell Phone:
Allergies or Health Concerns:
• Please note that the enrollment is complete when all required paperwork, documentation, and all applicable fees are received by school director and pre-entry meeting has occurred.
• A non-refundable registration fee of $100 is required to reserve a spot.
Photos: (check one)I DOI DO NOT give my consent to have my child’s picture printed in any publicity photographs, which may be taken while attending The Discovery Years. I understand that such a picture may be published in brochures, newspapers, and our website. I understand that there will be no recompense made to me/us for publication of any pictures used.
For us to apply diaper cream and/or sunscreen that you provide for your child, please initial here
Please sign below and return to the center’s director.
Parent/Guardian Signature:			Date:
Type Name Here will be considered as a Digital Signature
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