ENROLLMENT REQUEST FORM Child's Name and Nickname Child's Birthday * Gender Female Male Days of the week you are requesting. Specify Morning Program or Full-Day: * 1st Parent's Name Telephone Email 2nd Parent's Name Telephone Email Language(s) spoken in the home: Has your child had previous childcare experience out of your home? If so, where? * Describe your child's experience with a regular in-home caregiver other than a parent: What are you looking for in having your child attend this program? * Do you have any experience with Waldorf education? If so, please describe: * How did you hear about our program? THREE COMMUNITY AGREEMENTS We agree to strive to limit or eliminate media exposure and screen time in our child's life. * Yes No We agree to attend parent meetings and parent-teacher conferences (one parent required). * Yes No We agree to participate in community festival gatherings and work days (one parent required). * Yes No Please add any pertinent information related to the Community Agreements: The following questions are intended to help develop a picture of your child. Please communicate any special circumstances about which you'd like us to be aware. All information is strictly confidential. FAMILY QUESTIONNAIRE How would you describe your child? * What are your child's strengths and challenges? * What kinds of activities does your child enjoy most? Please describe your child's typical daily rhythm: How often does your child play outside? How does your child play alone? How does your child play with other children? Does your child attend any lessons or activities on a regular basis? If so, what and when? What cultural, religious or other traditions does your family celebrate? (Garden School welcomes children of all races, creeds, religions and ethnic backgrounds). Are there any special activites, cultural celebrations, foods or other experiences you would like to share with the children in our program? Is your child exposed to media, including television, movies, computers, hand held devices, video games or talk radio? Yes No If so, what programs? How often? When? Is your child toilet trained? * Yes No If yes, at what age? Dry at night? Does your child take naps? * Yes No If so, at what time(s)? For how long? If your child does not nap, do they have regular quiet time? If so, how do they handle quiet time? Does your child have a regular bedtime? If so, when? Does your child have any habits (thumb sucking , etc)? Describe any fears: Describe your pets: Does your child and/or other family members follow a special diet? Yes No If so, please describe: Has your child been evaluated by any medical, developmental or behavioral specialists? * Yes No If so, please describe: Medical history you'd like to add now (a Medical Evaluation Form is required before enrollment): Please add anything else that is pertinent to your child's biography: Thank you! Your Enrollment Form will be completed with $35 Application Fee payment.
