2012-2013 Online Application

Please fill out this application to be considered for enrollment for the 2012-2013 school year. You will also need to pay your non-refundable $35 registration fee. You can mail a check with your child’s name to:

CCNS
Attention Admissions:
569 South 1300 East
Salt Lake City, UT 84102

You can also pay your fee online, through paypal. Please refer to our online payments page to do so.

Child's Name *

Child's date of birth *

Gender *

Female

Male

Please Indicate your class preference: *

2-year-old • Tuesdays & Fridays • $140 a month

3-year-old • M, W, & TH • $165 a month

4-year-old • THREE DAY OPTION • M, W, & TH • $165 month

4-year-old • FOUR DAY OPTION • M, T, W, & TH • $200 a month

Parent 1 Information

Name *

Email *

Address *

Primary Phone Number *

Secondary Phone Number

Occupation *

Business Address

Parent 2

Name

Address if different from Parent 1

Phone Number

Secondary Phone Number

Occupation

Business Address

About You

Care to share more about the interests of Parent 1 or Parent 2? *

Please list any other experience/interests/hobbies/talents/contacts/connections that might be useful in the classroom or in serving on any of the parent committees which operates the school.

What was your reason for enrolling your child in nursery school? What would you and your child like to gain from this experience? *

How did you hear about our program? *

More About Your Child

Please list your child’s previous group experience: *

Please list any speech peculiarities, words for toilet, and anything else that might help your child to be more easily understood by others:

Please list any special interests or abilities of your child

Other children in the family

Name

Age

Relationship

CCNS Alumni? Year/Teacher

Name

Age

Relationship

CCNS Alumni? Year/Teacher

Name

Age

Relationship

CCNS Alumni? Year/Teacher

Please tell us a little more about your family

Are the child's parents living together? *

Yes

Other adults living in the home:

Pets in home:

Other languages spoken in home:

Health History

Family Doctor *

Family Doctor's Phone Number *

Family Doctor's Office Address *

Health Insurance Provider *

If none, please just type none

Card # *

Does your child have any physical limitations in activities or other issues relating to health? *

Yes

(Please describe in detail):

Please specify any dietary preferences or restrictions:

Does your child take any medications regularly? Please specify:

Allergies:

Please fill out the following

Applications will be reviewed in order of date received.
Multiple factors determine class selection and are ultimately up to the discretion of the school leadership.
If applying after March 31, 2012 please call the school to see if there are remaining openings for students before you submit an application.

CCNS admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students of the school. Neither does CCNS discriminate on the basis of race, color, national and ethnic origin in administration of educational policies, admission policies, and scholarship programs.

If you have any comments, concerns, or questions, please contact our director Angie Chatterton at director@ccnsslc.com or call 801.860.0910

2012-2013 Online Application

Parent 1 Information

Parent 2

Parent Commitment

Parent Code of Conduct

About You

More About Your Child

Other children in the family

Please tell us a little more about your family

Health History

Calendar

Bookmarks

2012-2013 Online Application

Parent 1 Information

Parent 2

Parent Commitment

Parent Code of Conduct

About You

More About Your Child

Other children in the family

Please tell us a little more about your family

Health History

Calendar

Bookmarks

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