Application Form

"*" indicates required fields

Child's Name*

First Last

Date of Birth*

Apply Year

Parent 1 – Full Name*

First Last

Parent 2 – Full Name

First Last

Address*

Street Address City State ZIP Code

Parent 1 – Cell Phone Number*

Parent 2 – Cell Phone Number

Parent 1 – Email Address*

Parent 2 – Email Address

Parent 1 – Occupation

Parent 2 – Occupation

Ages of other children in the family and (if applicable) school/s they attend.

Programs child has previously attended, if any:

What are your child’s special interests?

What are your thoughts and priorities in considering a preschool?

Please include any additional information that may be of help as we consider your child’s application.

How did you become interested in Chelsea Day School?*

Did you attend an Open House?*

Yes

If you are applying for our entry level 2/3s class, please tell us if you would prefer

3 mornings

5 mornings

Are you applying for financial aid?*

Yes

There is a $75.00 application fee.

Application Fee

Credit Card