Evergreen Learning Center Enrollment Form

This form may take between 30-45 minutes to complete. Please set aside the full amount of time to complete the enrollment form in one sitting to not risk losing your progress.

Child's Information

Parent / Guardian Information

Emergency Contact

Please list any additional emergency contacts authorized to act for the parents / guardians in case of an emergency.

Pick-up Authorization

Please list any additional contacts, other than parents/guardians and emergency contacts, authorized to pick-up your child:

Family Information

Please list all adults living in the child's household(s) and their relationship to the child (parents, grandparents, etc.).
Please list any other children in the family.

Media Consent

Please Understand: Your child will be photographed but images will not be shared publicly without your permission. Our staff will share photos of students (no names) in private social media groups accessed by ELC parents and staff.

Child's Medical Information

Child Personality Development

Eating Habits

Only fill out this section if your child is an infant.

Only fill out this section if your child is eating solid food

Sleeping Habits

Toileting Habits

Children in the 3 year old and 4 year old class must be fully potty trained.

Parent / Guardian Declarations

Child Care Agreement

Our Promise to you
  • Provide a loving, nurturing and supportive environment for children.
  • Offer opportunities for children to grow cognitively, emotionally, socially, and physically. 
  • Communicate pertinent information with you about your child and our program.
Your Promise to us
  • Follow all established Evergreen Learning Center policies and procedures.
  • Follow payment procedures in a timely and accurate manner.
  • Read and discuss rules and updates with your child.
  • Inform us of any changes in registration information, attendance, or payment options.

Parent / Guardian Signature

A $50 non-refundable registration fee must be submitted with this contract.