Enrollment Application
Child's Information
Child's Name
Child's Nickname
Birthday
Male/Female
Male
Female
Child's Address
Father (Guardian)
Name
Home Phone
Email
Cell #
Carrier
Driver's License #
Employed by
Mother (Guardian)
Name
Home Phone
Email
Cell #
Carrier
Driver's License #
Employed by
Describe any legal custody / visitation stipulations:
Do you receive reimbursement for childcare?
How did you hear about SFMB?
Siblings
Name
Age
Grade
Other persons living in household (include relationship and age)
Does child have a room alone? If not, with whom?
Who has cared for child other than parents?
Has child had group play experiences? Where?
Does child have neighborhood playmates? Older or younger than child?
Word child uses for urination?
Bowel movement?
Usual time for B.M.:
Usual time for meals:
Breakfast?
Lunch
Dinner
Any special dietary restrictions?
Go to sleep?
Awaken
Does child sleep well?
Select
Yes
No
Does child have any special fears?
Health Information
List past illnesses
Does child:
Run high fevers?
Select
Yes
No
Vomit easily?
Select
Yes
No
Have allergies?
Select
Yes
No
Please list and allergies:
Requesting Enrollment For:
Mind & Body Babies:
Days:
Hours:
Transition Toddlers:
Days:
Hours:
Terrific Two’s:
Days:
Hours:
Preschool Three Year Old:
AM
Preschool Four Year Old:
AM
Young Fives:
AM
Kindergarten:
AM
Blended Learning:
AM
Full Day
Latchkey - ASMG
Before School
After School
SFMB Tutoring
Day:
Hrs:
Detail your child’s schedule below
Monday
Tuesday
Wednesday
Thursday
Friday
Special enrollment for: Summer Explorers
Does your family need special scheduling arrangements? If yes, specify schedule:
Please briefly outline your goals for your child attending SFMB:
Submit Application