Admission Application

At this time, all SpringRose Childcare’s classes are full and not accepting new students.

Enrollment at SpringRose Childcare is open to children from 6 weeks to 14 years old. Enrollment shall be granted without regard to a child’s race, color, creed, religion, national origin, gender, or disability; and without regard to a parent or guardian’s race, color, creed, religion, age, national origin, gender, pregnancy or disability.

The only way to maintain SpringRose's high quality standards is to limit our overall class enrollments. Unfortunately, we sometimes do not have a space to offer prospective students. When classes are filled SpringRose will open a Waiting Pool for anyone wishing to be enrolled. Your child or children may be chosen within several weeks or it may take much longer. Priority is given to siblings of current students and students with a SpringRose Childcare relationship.

To be considered for enrollment and placed in the Waiting Pool, please complete the form below.

Asterisks (*) indicate a required field

Student Information
First name:
Middle name:
Last name:
Nickname:
Street address:
City:
State:
Zip:	(US ZIP Code (5 digits))
Gender:	Male Female
Date of birth:	(Date mm/dd/yyyy)
Current age:
Month / Year of proposed entrance:
Parent/Guardian Information
First name:
Middle name:
Last name:
Occupation:
Company:
Home street address:
Home city:
Home state:
Home zip:	(US ZIP Code (5 digits))
Home phone:
Home email:	(E-mail)
Home fax:
Company street address:
Company city:
Company zip:	(US ZIP Code (5 digits))
Company phone:
Parent/Guardian Information
First name:
Middle name:
Last name:
Occupation:
Company:
Home street address:
Home city:
Home state:
Home zip:	(US ZIP Code (5 digits))
Home email:	(E-mail)
Home phone:
Home fax:
Company street address:
Company city:
Company state:
Company zip:	(US ZIP Code (5 digits))
Company phone:
General Information
Student resides with:	Father Mother Both
Other:
Where should admissions material be sent?	Father Mother Both
Other:
Where should bills be sent?	Father Mother Both
Other:
If parents are divorced or legally separated, who has primary custody of the child?	Father Mother
Are you applying for childcare subsidy?
First language (other than English):
Language spoken at home:
Ethnicity:
Sibling's Information
Sibling name:
Age:
School:
Sibling name:
Age:
School:
Sibling name:
Age:
School:
Sibling name:
Age:
School:
Education Information
Present school/childcare:
Street address:
City:
State:
Zip:
Director:
Phone:
Fax:
Type of school/childcare:	Independent Private/Parochial Public
Dates of attendance:
Other Schools Attended in the Last Three Years
School name:
City:
State:
Zip:
Dates of attendance:
School name:
City:
State:
Zip:	(US ZIP Code (5 digits))
Dates of attendance:
Acknowledge:	By submitting this form, I aknowledge that all information provided is truthful, accurate and complete.