Student Last Name:

Student First Name

Gender: Male Female

Date of Birth: (e.g. 03/15/2001 Month/Day/Year)

Projected Start Date: (e.g. 03/15/2001 Month/Day/Year)

Grade Level for which the student is applying for:

School Year which the student is applying for:

Age or Grade of Child at Start Date:

Has the student ever attended a public school? Yes No

Where does your child currently attend or previously attended?

Is the student receiving special services? Yes No

If yes, explain below

Which location are your interested in?

If enrolling in the preschool, what hours will your child be attending?

Name of Parents/ Guardians:

Address: Street City State Zip Code

Home Phone Number: (e.g (305) 000-0000)

Work Phone Number: (e.g (305) 000-0000)

Cellular Phone: (e.g (305) 000-0000)

Other Phone: (e.g (305) 000-0000)

Email Address:

List all school-age siblings: (If applying for more then one child, please be sure to complete an entire application for each child as well as list the siblings in this section on each application.)

How did you hear about Smart Starts Day School?

PARENT’S OR LEGAL GUARDIAN’S SIGNATURE
DATE

I am over 18 years of age.

Mail/fax/e-mail your application to:
Smart Starts Day School

7990 SW 117 Avenue #210
Miami, FL 33183
Fax: (305) 595-8882

Email application@smartstartsdayschool.com

FOR SCHOOL USE ONLY

Date Received: _________ Processed By: __________ Tuition: __________ Schedule: _________