Premier Learning Academy Chandler Arizona

 Registration Form

New Page 1

Expected Start Date:

 

Child's Full Name:

Date of Birth:                             Gender:
         

Address:

City, State, Zip:

Phone:

Legal Last Name (If different from above)
Registration fee: $150 (non-refundable) paid at time of registration.

I accept that the monthly tuition is paid the first of every month regardless of the  number of days school is in session or my child attends:

I accept

PARENTS OR GUARDIANS

Mother/Guardians' Name:
  

Cell/Pager Number:
  

Home Address:

City, State, Zip Code:

Home Phone:

 

Work Phone:

 

Employer:

Occupation:

Email Address:

 

Relationship to Child:

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Father/Guardians' Name:
  

Cell/Pager Number:
  

Home Address:

City, State, Zip Code:

Home Phone:

 

Work Phone:

 

Employer:

Occupation:

Email Address:

 

Relationship to Child:

Child Lives Primarily With (please mark all that apply:      Mother  Father 

Step-Parent Name:  

Grandparent Name:

Foster Family Name:  

Other Name:

If Divorced, do you have joint custody?

If No, do you have custody documents?

Potty Training:        Does Your Child Nap?

           

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