Starseed Application 2018/19

Child's Name *
Child's Name
Child must be 3 years old before start date
Full Enrollment is open only to 5-6 year olds
Parent Name *
Parent Name
Phone *
Phone
Phone 2
Phone 2
Address *
Address
Parent Name 2
Parent Name 2
Phone
Phone
Phone 2
Phone 2
Address 2
Address 2
Complete if child lives in two households
Primary care physician *
Primary care physician
Physician phone number *
Physician phone number
It is a requirement that all Starseeds be fully toilet trained before joining our program.
a. Interactions with peers b. Interactions with adults c. Ability to understand spoken directions d. Coordination (large motor skills)