The Fox Den Registration for Enrollment

The Fox Den Early Learning Academy is now accepting pre-registration. Registrants are required to submit the required information and pay the security deposit of $100, per student. Please complete the registration form below to start the enrollment process.

1Student Info > 2Parents Info > 3Additional Contacts > 4Emergency Contacts > 5Confirm Payment > 6Payment
Student Information

Please complete the required student information in this section.
Registration Date Registration Date * / MM / DD YYYY
Student First Name *
Student Middle Name
Student Last Name *
Nickname
Sex
Age *
Date of Birth Date of Birth * / MM / DD YYYY
Home Address Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Student's primary residence.
Name of public or private school child attends, if any.
Provide Medical Information? *

Provide Medical Information? Yes No
Student Medical Information

Please provide any information about the student's special or medical needs.
My child has special needs. *

My child has special needs. Yes No
Please detail any special needs or accommodations that may be needed to satisfy your child's needs. *
My child has allergies. *

My child has allergies. Yes No
Specify Allergies *

Specify Allergies Coconut Corn Dairy Eggs Fish Gluten Milk Mustard Peanuts Sesame Shellfish Soy Tree Nuts Wheat Not Listed Not Listed
My child is currently on medication(s) prescribed for long-term continuous use and/or has an illness or other health concern. *

My child is currently on medication(s) prescribed for long-term continuous use and/or has an illness or other health concern. Yes No
Please provide more information about your child's health concerns, including medications. *
Child's Doctor's Name Child's Doctor's Name First Last
Child's Doctor's Phone Child's Doctor's Phone - ### - ### ####
$0

Total

The Fox Den Registration for Enrollment

The Fox Den Registration for Enrollment

Student Information

Student Medical Information

$0

Total

$`0`