Enrollment Application

Child Information

Full Name

Age

Date of Birth

Month

Day

Year

Gender

Male

Female

Requested Start Date

Month

Day

Year

Parent/Legal Guardian Information

Name

Relationship

Phone

Address

Name

Relationship

Phone

Address

Attendance

Attendance is currently offered on a 5-day (Monday-Friday), 3-day (Monday, Wednesday, Friday) and 2-day (Tuesday, Thursday) basis within operational hours of 7:30 a.m.-5:30 p.m. We ask that drop offs occur prior to 9 a.m. and pick up during naptimes are avoid when possible.

Desired Attendance Schedule

5 days (Monday-Friday)

3 days (Monday, Wednesday, Friday)

2 days (Tuesday, Thursday)

Other

If Other, Please Expand:

Estimated Drop Off Time

Time

HoursMinutes

Estimated Pick Up Time

Time

HoursMinutes

Would you like to be notified of an opening in your child's age group even if it does not match your requested schedule/start date?

Yes

How did you learn about Moscow Day School?

Any Additional Comments/Questions