Pre-Enrollment Form

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Consultation
Enrollment

Home
Services
- Virtual K-12 Program
- K-12 Physical location
Staff Directory
Blog
Contact
Consultation
Enrollment

Join Our Team

Click Here to Book a Consutation First ?

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Student Name *

First

Last

Student date of birth *

MM/DD/YYYY

Students age *

Previously attended school or daycare

Does your child struggle with any of the following on a regular basis

ADHD
Autism
Dyslexia
Speech/Language Delay
ODD
Sensory Processing Disorder

What are your primary seasons for enrolling your child in our daycare?

Full-time care while working
Part-time care while working
Academic preparation for school
Special enrichment programs (Language, STEM, Quran studies)

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone *

in Name Stripe

What are your biggest hopes and concerns for your child while they are in our care? *

Check for confidentiality

This allows parents to share their person insights about their childs needs,expectations, and any worries they may have, helping your provide the best care possible.

I agree to the following charge: *

Registration Fee - $250.00

Stripe Credit Card *

Pre-Enrollment Form

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