Home About Why Us Testimonials Locations Take a Tour Programs Our Team Meet Our Team Join Our Team Ask the Experts Blog/FAQ Contact Step 1 of 4 25% Name* First Last Nickname Birth Date* Date Format: MM slash DD slash YYYY Sex* Male Female Enrollment Date* Date Format: MM slash DD slash YYYY Enroll a second childYesNoSecond ChildName* First Last Nickname Birth Date* Date Format: MM slash DD slash YYYY Sex* Male Female Enrollment Date* Date Format: MM slash DD slash YYYY Enroll a third child?YesNoThird ChildName* First Last Nickname Birth Date* Date Format: MM slash DD slash YYYY Sex* Male Female Enrollment Date* Date Format: MM slash DD slash YYYY Address Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Parent/Guardian InformationParent's/Guardian's Name*Phone*Email* Work Phone*Parent's/Guardian's NamePhoneEmail Work PhoneEmergency ContactsNameRelationship to ChildAddressPhoneNameRelationship to ChildAddressPhone No Emergency Contacts Available, Other Than Parents No Persons Authorized to pick up the child, Other Than Parents Out of Area/State Contact NameRelationship to ChildAddressPhone No Out of Area/State Contacts Available In case of an emergency or a serious illness and the parents cannot be reached immediately, I hereby authorize the provider to obtain emergency medical care and/or provide emergency medical transportation for my child. Parent's/Guardian's Signature*Date* MM DD YYYY I Hereby give the provider permission to transport my child in the provider's vehicle for the following (optional): To and From School On Field Trips (with written permission in advance) Other Parent's/Guardian's Signature*Date* MM DD YYYY Child Health Assessment There must be a separate health assessment form for each sibling.Name of Child*Birth Date* Date Format: MM slash DD slash YYYY Check All That Apply: Does your child have any known allergies or sensitivities to:Medications* No Yes If Yes, please list:Foods* No Yes If yes, please list:Other* No Yes If yes, please list:Illnesses or Medical Conditions: Does your child have any of the following conditions?Asthma* No Yes Visual Impairment* No Yes Diabetes* No Yes Developmental Delays* No Yes Seizures* No Yes Physical Impairment* No Yes Heart Problems* No Yes Behavioral or Emotional Problems* No Yes Hearing Impairment* No Yes OtherList any addictional health information or special instructions you feel we need to be aware of:List any regular medications your child takes:Name of Child's Medical Provider*Signature*Date* MM DD YYYY Child Health Assessment There must be a separate health assessment form for each sibling.Name of Child*Birth Date* Date Format: MM slash DD slash YYYY Check All That Apply: Does your child have any known allergies or sensitivities to:Medications* No Yes If Yes, please list:Foods* No Yes If yes, please list:Other* No Yes If yes, please list:Illnesses or Medical Conditions: Does your child have any of the following conditions?Asthma* No Yes Visual Impairment* No Yes Diabetes* No Yes Developmental Delays* No Yes Seizures* No Yes Physical Impairment* No Yes Heart Problems* No Yes Behavioral or Emotional Problems* No Yes Hearing Impairment* No Yes OtherList any addictional health information or special instructions you feel we need to be aware of:List any regular medications your child takes:Name of Child's Medical ProviderSignature*Date* MM DD YYYY Child Health Assessment There must be a separate health assessment form for each sibling.Name of Child*Birth Date* Date Format: MM slash DD slash YYYY Check All That Apply: Does your child have any known allergies or sensitivities to:Medications* No Yes If Yes, please list:Foods* No Yes If yes, please list:Other* No Yes If yes, please list:Illnesses or Medical Conditions: Does your child have any of the following conditions?Asthma* No Yes Visual Impairment* No Yes Diabetes* No Yes Developmental Delays* No Yes Seizures* No Yes Physical Impairment* No Yes Heart Problems* No Yes Behavioral or Emotional Problems* No Yes Hearing Impairment* No Yes OtherList any addictional health information or special instructions you feel we need to be aware of:List any regular medications your child takes:Name of Child's Medical Provider*Signature*Date* MM DD YYYY Downtown Salt Lake 35 East 500 South Salt Lake City, UT 84111 385-468-7751 Like us on Facebook! 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