Welcome Our Services Apply Online Contact Info
The Children's ArcThe Children's ArcPre-School and Child Care
Tutoring

Beach Location (757) 422-1325

Norfolk Location (757) 855-6317

First Name
Last Name
Nickname
Address
City
Zip
Childs Information:
Phone #
Sex:
Male
Female
Date of Birth
Fathers Information:
First name
Last name
Address
City
Zip
Phone
SSAN
Employer Name
Employer Address
City
Zip
Work Phone
Cell Number
Mothers Information:
First Name
Last Name
Address
City
Zip
Employeer Name
Employeer Address
City
Zip
Work Phone
Cell Phone
Person(s) or Agency Having Legal Custody of Child:
First Name
Last Name
Address
City
Zip
Employer Name
Employer Address
City
Zip
Work Phone
Cell Phone

Emergency Information:

Allergies/Intolerance to Food/ Medication Etc.
Action to be Taken in case of Emergency
Child's Physician
Physicians Phone Number

People to Contact if Parents Cannot be Reached (two contacts mandatory):

First Name
Last Name
Address
City
Zip
Phone
First Name
Last Name
Address
City
Zip
Phone
Person(s) Authorized to pick up child:
First Name
Last Name
First Name
Last Name
Person(s) Not Authorized to pick up child:
First Name
Last Name
First Name
Last Name
Legal Paperwork when release not auhtorized

Special Needs:

List any chronic Physical Problems / Pertinent Developmental Information / Special Needs

Current and Previous Schools

Does your child attend another school in addition to The Childrens Ark?
Yes
No
Name
Number
Grade
List Previous Schools / Daycares
Name
Address
City
State
Zip
Phone Number
Name
Address
City
State
Zip
Phone Number
How did you hear about us?

Parent/Gaurdian

If yes please provide Schools name, number and grade
Enrollment Application
Site Manager Sign In

Powered By
Yellow Pages
Yellow Pages