Application

Please use the form below to apply to the school. We will confirm receipt within 2 business days.

Need assistance? Call 914.273.3291 during normal business hours.

Fields marked * are required.

Child

First Name *

Last Name *

Nickname

Date of Birth *

Sex

Age when starting

Home Phone

Date to begin school

Previous school(s) attended

Child lives in the custody of

Child's Health & Development

Does your child have any known medical conditions, allergies or medical requirements?

Yes No

Does your child have any disabilities, developmental delays, receive any special education / therapeutic services or have special behavioral needs?

Yes No

Does your child have any non-medical food restrictions?

Yes No

Family

Home Address

Street Address *

City *

State

Zip

Parent / Guardian 1

First Name *

Last Name *

Email *

Cell #

Business Phone

Place of Work

Profession

Parent / Guardian 2 (if applicable)

First Name

Last Name

Cell #

Business Phone

Place of Work

Profession

Same address as primary home address above

Siblings

First Name

Last Name

Date of Birth

Emergency Contacts

Other than parents / guardians

First Name

Last Name

Relation to child

Phone

Primary Care Physician

Name

Phone

Authorized Pick Up

The following people are authorized to pick up / drop off my child

First Name

Last Name

Relation to child

Phone

Photo ID will be required for all non-custodial pick ups. Written notice is required for all pick ups not named above.

Registration Options

Permissions

I give permission for my child to receive emergency medical treatment

Yes No

I give permission for my child to have photos and video appear on the school website as described in the Policies & Information statement

Yes No

I would like my contact information published in the school family directory (only if enrolled)

Yes No

Additional Comments

Agreement

An application fee of $295.00 and one month's tuition is due upon acceptance of your child into the program. All above fees are non-refundable. All applications are subject to a two week trial period. I understand and agree to pay the required tuition fees and that my obligation to pay the tuition fees for the program I have selected, as per payment schedule, is unconditional. No portion of tuition paid will be refunded in the event of absence, withdrawal or dismissal.

I have read the school Policies and Information statement and agree to abide by the same in the event my child is accepted.

I have read and agree to the terms above. By checking this box I confirm that I am the person named below and that this constitutes my legal electronic signature. *

Parent / Guardian Signature (type full name) *

Date *