Prospective Day School Application – Saint Anne's Day School & Enrichment Programs

Child's Full Name *

Gender *

Name Called *

Date of Birth//

Home Phone Number *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent 1 *

Work Number *

Cell Number *

Parent 2 *

Work Number *

Cell Number *

Email Address *

School year child is applying for *

Does your child have a sibling(s)? *

Sibling

Date of Birth//

Sibling

Date of Birth//

Sibling

Date of Birth//

Sibling(s) currently enrolled at Saint Anne's?

Which program? *

Are you an active pledging member of St. Anne's Episcopal Church? *

Do you have an interest in our full day care for Pre-Kindergarten and Kindergarteners? *

This is NOT a registration form. You will be contacted when space becomes available.

AN ADMINISTRATION FEE OF $55 IS DUE AT THE TIME OF SUBMISSION.