Order Number Child's Full Name * Gender * Name Called * Date of Birth * Home Phone Number * Home Address * City * State * Zip Code * Parent 1 * Parent 2 * Work Number * Work Number * Cell Number * Cell Number * Email Address * School year child is applying for * 2017-2018 2018-2019 2019-2020 Does your child have a sibling(s)? * Yes No Are you an active pledging member of St. Anne's Episcopal Church? * Yes No Do you have an interest in our full day care for Pre-Kindergarteners and Kindergarteners? * Yes No 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.