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Enrollment Application
| Mornings: MWF ______ TTH ______ Afternoons _____________________ |
Telephone: 517.349.4877 Email: renae@ons-online.com 2165 Clinton Street Okemos, MI 48864 |
| CHILD'S NAME _____________________ NICKNAME _____________ GENDER ____ | |
| MOTHER'S NAME ____________________ FATHER'S NAME ____________________ | |
| ADDRESS
________________________________________ PHONE _______________ (Street City Zip Code) |
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| BIRTHDATE ___________________ EMAIL ADDRESS _________________________ | |
| FATHER'S EMPLOYER ___________________________ PHONE _________________ | |
| OCCUPATION ________________________________ HOURS ___________________ | |
| MOTHER'S EMPLOYER __________________________ PHONE __________________ | |
| OCCUPATION ________________________________ HOURS ___________________ | |
| OTHER CHILDREN IN FAMILY __________________________ AGE _____________ | |
| __________________________________ AGE _____________ | |
| EMERGENCY CONTACT (OTHER THAN PARENTS) | |
| NAME __________________________________________ PHONE _________________ | |
| ADDRESS _____________________________ RELATIONSHIP TO CHILD _________ | |
| FAMILY DOCTOR ________________________________ PHONE _________________ | |
| ADDRESS _____________________________________ HOURS ___________________ | |
| PLEASE USE THIS SPACE
TO SHARE WITH US ANY SPECIFIC EXPECTATIONS YOU MAY HAVE FROM THIS
PROGRAM OR ANY SPECIAL INFORMATION THAT YOU WISH US TO BE AWARE OF
REGARDING YOUR CHILD. (ALLERGIES etc.) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ |
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| FOR SCHOOL USE ONLY: DATE OF ENTRY _____________________ DATE OF DISCHARGE _______________ |
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$200 due with application. $50 is a
nonrefundable registration fee and $150 is a defrayment fee to the
specialty classes offered.
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