Registration Form

Louise M. Beem Early Childhood Center
Application for Enrollment

NOTE: When you accept an offer of enrollment in the Early Childhood Center, a registration fee is required to secure your child’s enrollment. If you are enrolling your child for full-time classes, a security deposit equal to two weeks' tuition is also required.

I am applying for enrollment in:
Full-Time Toddler
Full-Time Preschool
Full-Time Kindergarten
Academic Day Kindergarten (if available)
Part-Time Preschool (3-Year-Old Class)
Part Time Preschool (Mixed-Age Class)
Part-Time Preschool (4-Year-Old Class)

If applying for enrollment in the full-time program, when would you like your child to begin?

Child's Name Sex (select one): M F
Birthdate

Parent/Guardian's Name
Address
City State ZIP
E-Mail Address
Phone: Home Cell
Parent/Guardian's Name
Address
City State ZIP
E-Mail Address
Phone: Home Cell

Additional information about your child or questions you might have:

NOTE: A separate Application for Enrollment form is required for each student.