Full Name:
Email Address:
Phone:
Alt. Phone:
How would you liked to be contacted?
Choose One
Email
Phone a.m.
Phone p.m.
Child's Full Name:
Your Child's Birthdate:
I am interested in enrolling my child in the:
Choose One
3 Year Old Pre-School Program (a.m.)
3 Year Old Pre-School Program (p.m.)
3 Year Old Pre-School Programs (both a.m. & p.m.)
4 Year Old Pre-School Program (a.m.)
4 Year Old Pre-School Program (p.m.)
4 Year Old Pre-School Programs (both a.m. & p.m.)
Kindergarten
Which year would your child be attending The Academy at St. Polycarp?
Choose One
2007-2008
2008-2009
2009-2010
2010-2011
2011-2012
List your Child's Previous School or Daycare (if any):
How did you hear about The Academy at St. Polycarp?
