The Children’s Place Learning Academy
Welcome
About Us
Enrollment
Non Refundable Supply Fee
Infant Info
About Your Child Enrollment
Routine Trip Enrollment
Child Enrollment and Health Information
Food Erollment Form
Child Medical Statement Form
Permission to Photograph
Calendar
Events
Careers
Contact us
Menu
Welcome
About Us
Enrollment
Non Refundable Supply Fee
Infant Info
About Your Child Enrollment
Routine Trip Enrollment
Child Enrollment and Health Information
Food Erollment Form
Child Medical Statement Form
Permission to Photograph
Calendar
Events
Careers
Contact us
Food-Erollment-Form
Food Erollment Form
FOOD ENROLLMENT
Download Food enrollment Form
Fill your details
First Name
MIddle Name
Last Name
Adress
City
State
Zip Code
Child's Date of Birth
Enrollment Date
Sex
Male
Female
First Name
MI
Last Name
Adress
City
State
Zip Code
Home Phone
Work Phone
Sex
Male
Female
Email
Over Night Stay Approved
Yes
No
Work Schedule
Do Not Work
Typical 9 to 5
Night Shift
Work Schedule Varies
Formula Option
Parent Supplies Breast Milk of Formula
Parent Accepts Provider-Supplied Formula
Name of Parent Formula
Food Option
Parent Supplies Additional Food and Refuses Provider's Foods
Provider Supplies Additional Food when Developmentally Appropriate
Payment Source
Private/No Pa
DHS/Country
School Info
School Age
Home School
All Year School
AM Kindergarten
PM Kindergarten
All Day Kindergarten
AM Headstart
PM Headstart
All Day Headstart
Ethnicity
Hispanic/Latino
Not Hispanic or Latino
Race
American Indian/ Alaska Native
Asian
Black or African American
Native Hawaiian/ Pacific Islander
White
School Name
School Number
School District
School Depart Time
Return Time
Day Attending School
Monday
Tuesday
Wednesday
Thursday
Friday
I anticipate the Days my child will participate will be
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Days will vary
Drop off Time
Pick Up Time
I anticipate the Meals my child will participate will be
Breakfast
AM Snack
Lunch
PM Snack
Dinner
Evening Snack
Parent/Guardian Signature
Date
Submit Details
NOW
ENROLLING
Enrollment is open to children from Infant to 12 years of age
Now Enrolling
