Gender: GenderMaleFemale
Birth Date:

Street Address:


State: AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Explain any allergies, special medical needs, food restrictions:

Child's Physician Information

Starting Date
Our academic year starts Monday 8/25/2025 to coincide with Baltimore County Public Schools.

Applications requesting a later starting date will be processed last, if any openings remain.

Enrollment Start Time:
Choose TypeContinuing StudentNew Student Starting 8/25/2025New Student Starting on Other Date

If you chose to start on another date, what date:

Enrollment Type
We are a full year facility. Children withdrawn for the summer or other period cannot be re-enrolled.

Choose Type of enrollment:
Type of EnrollmentFull YearTemporary (enter dates below)

If you chose temporary, enter the start and end dates:
Start Date:
End Date:

Lunches
Do you want to purchase catered lunches or send them from home? Catered lunches, if available, are provided by an outside vendor on a monthly basis. We'll bill you for each month in advance. To cancel, just notify us before the month billed for starts. Sorry, but they cannot accommodate special dietary needs.

Lunch Choice:
Lunch ChoicePurchase LunchesSend Lunches from Home

Parents / Guardians Authorized To Pick Up Child

Choose an option:
Authorized To Pick UpBoth Mother & FatherMother ONLYFather ONLY

Legal Custodian 1:

Legal Custodian 2:

Other Persons Authorized To Pick Up Child
In addition to the authorized pickup persons noted above, please use this box to list additional persons. Please provide their Name, Relationship to Child, Full Home Address, and a Contact Phone Number for each:

Authorized Pickup Person 1:

Authorized Pickup Person 2:

Authorized Pickup Person 3:

Authorized Pickup Person 4: