The Early Education Center of Seagull Schools, Inc
Seagull School
1300 Kailua Road, Kailua, Hawaii 96734 Phone: 261-8534
ENROLLMENT APPLICATION TODAY’S DATE
The Early Education Center Kailua Kapolei Ko Olina Ocean Pointe
Please enclose a $50 processing fee for each child with the enrollment application.
CHILD’S NAME
Last First Middle Preferred
SEX BIRTHDATE / / CHILD’S SS# XXX-XX- PHONE
ADDRESS
Street City Zip Code
Parent’s/ Guardian’s Information Parent’s/ Guardian’s Information
Natural Legal Guardian Natural Legal Guardian
Step Other Step Other
NAME NAME
SS# XXX-XX- SS# XXX-XX-
ADDRESS ADDRESS
OCCUPATION OCCUPATION
EMPLOYER EMPLOYER
ADDRESS ADDRESS
Are you an Emergency Required Worker? Yes No Are you an Emergency Required Worker? Yes No WORK PHONE WORK PHONE
CELL PHONE CELL PHONE
EMAIL ADDRESS EMAIL ADDRESS
LEGAL GUARDIAN’S NAME (Other than parent)
ADDRESS PHONE
LIST PERSON’S (other than parent or guardian) WHO ARE AUTHORIZED TO PICK UP YOUR CHILD FROM SCHOOL
1. Name Relationship
Address Phone
2. Name Relationship
Address Phone
3. Name Relationship Address Phone
LIST FAMILY MEMBERS IN THE HOME (if additional space is needed, attach sheet to application)
1. Name Relationship Age
2. Name Relationship Age
3. Name Relationship Age
I HEARD ABOUT SEAGULL SCHOOLS: Yellow Pages Friend Advertisement (Newspaper/Magazine)
(Please check all that apply) Referral Internet Other
MY REQUESTED START DATE IS . I UNDERSTAND I WILL BE CONTACTED WHEN THERE
IS A SPACE FOR MY CHILD. ENROLLMENT BETWEEN OCTOBER AND MAY IS LIMITED.
Parent/Guardian’s Signature__________________________________________________
|FOR OFFICE USE ONLY |DATE |INITIAL |CHK/REF# |AMOUNT |
|START DATE | |APPLICATION FEE | | | | |
|CLASS | |DEPOSIT | | | | |
|COPY (BUS.OFC) |DATE | | | | | |
| |INITIAL | | | | | |
|FULL TIME | |FIRST MONTH’S TUITION | | | | |
|PART TIME | |COMPREHENSIVE FEE | | | | |
| | | | | |TOTAL | |
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