Friends & Family Application

Program Options:(Required)
Please select all Programs that you are interested in:
After School Specials (beginning at 3pm):
Please select all Specials that you are interested in:

Child's Information

MM slash DD slash YYYY
Sex/Gender:(Required)
Home Address(Required)

Parent/Guardian 1 Information

Name(Required)
Home Address(Required)

Parent/Guardian 2 Information

Name(Required)
Home Address(Required)

Emergency Contact 1

Each child is required to have an additional two emergency contacts. These are people we would reach out to if we are unable to reach a parent/guardian.
Name(Required)

Emergency Contact 2

Each child is required to have an additional two emergency contacts. These are people we would reach out to if we are unable to reach a parent/guardian.
Name(Required)

The below information helps us to understand the family dynamics.

Parent Status – Parents are:(Required)
Who is enrolling the child?(Required)
Who is responsible for payment?(Required)
Is there any legal paperwork pertaining to your child that we should be aware of? (This can include custody agreements, IEP paperwork, etc.)(Required)

Medical Information

Please be honest and as detailed as possible. This information will help us to be more informed on your child’s medical history and provide care to the best of our abilities. There may be additional documentation or training that we will need from you and/or your child’s physician.
Do you have any concerns about your child's development?(Required)
Does your child currently have any limitations to physical activity?(Required)
Does your child require any special equipment for daily activities?(Required)
Has your child had any serious injuries or hospitalizations that we should be aware of?(Required)
Does your child require medication or treatment every day or as needed?(Required)
Does your child have any known allergies?(Required)

All About Me

Child Developmental Insights: We believe that you are your child’s first and most important teacher. We believe that education is a partnership between home and childcare/school. To begin this communication, please take some time to tell us a little about your child.
Child's Name(Required)
Are there other siblings/family in the home?(Required)
Has your child participated in a group care setting previously?(Required)
Do you have back up care arranged in case of illness or center closure?(Required)
Does your child sleep through the night?(Required)
Does your child nap?(Required)
Are there any dietary food restrictions?(Required)

Inde Elementary & Home School Hangout

If you interested in the Inde Elementary or Home School Hangout program, please fill out the below section. If you are not interested in this program, please skip this section by scrolling to the bottom, and submit the application.