Application for Enrollment
Child's Name
Birthdate
-
Month
-
Day
Year
Date
Place of Birth
Applicant's Parent(s) or Guardians Names:
Siblings (if any) and ages:
Parent(s) best contact number:
Applicant's address (please list all if more than one):
Please describe your child's birth story in the space provided below:
Was your child breastfed?
If so, how long?
When did your child's first teeth come in?
When did your child begin to walk?
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Has your child taken any medications? (if so, please list)
Has your child experienced any major operations or illnesses?
Do you have any health concerns with your child?
Does your child have any food allergies or sensitivities? (if so, please list)
Does your child watch television, movies, videos or play computer/video games?
If yes, how many hours per day? Per week?
What time does your child go to bed each night?
Is your child potty trained?
Does your child have any physical characteristics that need special attention?
Does your child take a nap at home? If so, at what time and for how long?
Please describe how you see your child socially with peers:
Please share how your child interacts in nature:
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Does your child have any particular 'favorite' things right now that they enjoy? Please describe:
Please share below anything else about your child that you consider special and unique (add additional paper if necessary):
Please list any schools or daycare your child has attended and when:
Please write what interests you most about a Waldorf-inspired, Earth based education for your child:
Once completed, please scan and email to River Bergquist at rivermeleaina@gmail.com or
Mail to:
Mele'aina
P.O. Box 746
Kula, Hl. 96790
Mahalo for your interest in the Mele'aina playgroup! All applicant families will be contacted soon after receiving the completed application form. I look forward to meeting your young ones soon!
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Application Fee
$
50.00
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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