Cental Florida ARR Learning Centers and South Florida Learning Centers
Enrollment Application
 
   
CHILD 1:
 
Child's Name:
Preferred Name:
Birth Date:
    Sex:       Male: Female:
Address:
City:
 State: Zip Code:
 
 
   
CHILD 2:
 
Child's Name:
Preferred Name:
Birth Date:
    Sex:       Male: Female:
Address:
City:
 State: Zip Code:
 
 
 
CHILD 3:
  
Child's Name:
Preferred Name:
Birth Date:
    Sex:       Male: Female:
Address:
  
City:
 State: Zip Code:
 
 
     
PARENT \ GUARDIAN 1:
  
Parent Name:
Parent Address:
Email:
 
Home Phone:
   Work Phone:
Cell Phone:
   Other:
Place of Employment:
 
 
PARENT \ GUARDIAN 2:
  
Parent Name:
Parent Address:
Email:
 
Home Phone:
   Work Phone:
Cell Phone:
   Other:
Place of Employment:
 
 
 
OTHER PERSONS TO BE NOTIFIED IN CASE OF ILLNESS OR ACCIDENT:
Name:
    Phone:
Relation:
    Cell Phone:
Name:
    Phone:
Relation:
    Cell Phone:
 
 
 
**PERSONS PERMITTED TO REMOVE CHILD FROM CENTER:
(Please specify yes or no)
Mother: Father:    
Name: Relation: Phone Number:
Name: Relation: Phone Number:
Name: Relation: Phone Number:
** All permitted persons must show picture identification**
 
 
 
**RELEASE FORM:
Is there any court order restricting visitation or pick up of your child? If so, please list person or persons restricted from picking up your child.
Name: Relationship:
Name: Relationship:
**Court Documentation must be provided to the school**
 
 
 
PROGRAM / CLASS:
Infants: Toddlers: Two's:
Pre-School: Prep:
Full Time: Part Time: Drop-In: Holiday Only:
Summer Camp: Before/After School Care:
Elementary School:
Date of Enrollment: