Name of child____________________________________________________________________
Gender __________________ Date of Birth _______________________________________
Desired start date (month/year): _____________________________________________________
Siblings (and their ages) ___________________________________________________________
Parent/Guardian #1
Name
Relationship to Child
E-mail Address
Home Address
Home Phone
Occupation
Company Name
Business Phone
Parent/Guardian #2 (if information different than #1)
Name
Relationship to Child
E-mail Address
Home Address
Home Phone
Occupation
Company Name
Business Phone
*Please indicate your ideal schedule, and we will do our best to accommodate you.
AM = 8:30-11:30
PM = 1-4
Full Day = 8:30-4.
2 days are usually T/Th, 3 days are usually M/W/F; however 2, 3, and 4 day schedules may be flexible (M/W or T/Th/F for example).
2, 3, 4, or 5 days/week: _______
AM or PM or Full-day: _______
1) Are you especially interested in joining with another family/child? If so, please let us know, and we’ll do our best to accommodate your wishes.
2) How did you hear about The Garden House / Le Jardin Enchanté?
3) Please tell us why (in English or French) you are interested in having your child attend The Garden House / Le Jardin Enchanté and also who, if anybody, speaks French in the home.