Application For Admission
Today’s Date _________________________ Desired Starting Date ______________________
CHILD INFORMATION
First Name: ______________________________ Last Name:_______________________________
Street: ____________________________________________________________________________
City: State: ZIP: _____________________________________________________________________
Birth date: _____________________________________________Check one: ___ Male ___ Female
Lives with: _____Both parents ____ Mother _____ Father _____ Other __________________________
Any allergies that child has: _____________________________________________________________
PARENT/GUARDIAN INFORMATION
Child’s Mother_______________________________________ Occupation_______________________
(or Guardian 1)
Home Tel:____________________________ Cell Tel:_____________ Work Tel:____________________
Home Address (if different from Child’s): ______________________________________________________
Employer: ____________________________________________________________________________
E-mail ______________________________________________________________________________
Child’s Father_______________________________________ Occupation________________________
(or Guardian 2)
Home Tel:_____________________________ Cell Tel:_____________ Work Tel:____________________
Home Address (if different from Child’s): ______________________________________________________
Employer: ____________________________________________________________________________
E-mail _______________________________________________________________________________
Parent(s)/Guardian(s) are: ___ Married ___ Single ___ Separated ___ Divorced ___ Widowed
___ Grandparent(s) ___ Legal Guardians ___ Other (please explain): ________________________
Please share with us your goals for your child.
__________________________________________________________________
__________________________________________________________________
How do you see your child’s learning style, social and emotional interactions?
__________________________________________________________________
__________________________________________________________________
What do you expect the school to do for your child?
__________________________________________________________________
__________________________________________________________________
Please share with us any medical history that would help us to better understand your child.
__________________________________________________________________
How did you learn about West Hollywood Children’s Academy?
__________________________________________________________________
Additional comments or observations you feel we should know to help us understand your
child better: ___________________________________________________________________________
______________________________________________________________________________________
Name of Parent/Guardian completing this form ____________________________________________
Signature of Parent/Guardian completing this form ___________________________________________
Date: ___ / ___ / ___
*Please return your application with a photo of your child and $100 Non-refundable Application fee. Application fee could be used towards enrollment fee. Thank you!
but also by the heart."
– B. Pascal
