Welcome to ENLA Learning

Enrollment
Form

A Montessori-inspired private academic school and licensed early education center serving children ages six weeks through five years. Please complete every required field. Only the Secondary Parent or Guardian block and Emergency Contact 2 are optional.

Chapter One
01

Your Family

The program you are applying for, your child, and the parents or guardians who will be raising them alongside us.

Subsections1.1 — 1.4
Time≈ 6 Minutes
RequiredAll Fields

Program & Child

1.1 · Program Selection

Select the program for your child.

Program
Requested Start Date
Full-Time Schedule
Part-Time Schedule
If Part-Time, Preferred Days
1.2 · Child Information

Tell us about your child.

Legal First Name
Middle Name
Last Name
Preferred Name (If Different)
Date Of Birth
Gender
Home Address
City, State, ZIP

Parents & Guardians

1.3 · Primary Parent or Guardian

Our first point of contact for your child.

Full Name
Relationship To Child
Phone (Mobile)
Phone (Work)
Email Address
Home Address (If Different From Child's)
Employer Or Organization
Work Address
1.4 · Secondary Parent or Guardian Optional

A second adult we can reach throughout the day.

Full Name
Relationship To Child
Phone (Mobile)
Phone (Work)
Email Address
Home Address (If Different From Child's)
Employer Or Organization
Work Address
Chapter Two
02

Care Network

The people we are authorized to call, the people authorized to pick up, and any legal arrangements that affect either.

Subsections2.1 — 2.3
StageRequired
Photo IDRequired At Pickup

Emergency Contacts

2.1 · Emergency Contacts

Two people we may call if a parent or guardian is unreachable.

Eligibility
Emergency contacts must be eighteen or older.
These individuals may be asked to pick up your child if you cannot be reached. Photo identification is required at pickup.
Emergency Contact 1
Name
Relationship To Child
Phone (Primary)
Phone (Alternate)
Emergency Contact 2 Optional
Name
Relationship To Child
Phone (Primary)
Phone (Alternate)

Authorized Pickup

2.2 · Authorized Pickup List

List everyone authorized to pick up your child.

Do not include parents or guardians already listed in Chapter One. Photo identification will be requested at every pickup, even from familiar faces.

Full NameRelationshipPhone Number
Restricted Pickup
Is there anyone NOT authorized to pick up your child?
If yes, please provide names below and any supporting documentation, including court orders or custody agreements.
Restriction
If Yes — Names And Documentation

Custody & Legal

2.3 · Legal Arrangements

Anything we should know to keep your child safe.

Are There Any Court Orders, Custody Agreements, Or Legal Arrangements?
Confidentiality
Legal documents are reviewed only by the director and held in confidence.
We follow the most recent valid order on file. If your circumstances change, please update us in writing as soon as possible.
Chapter Three
03

Health & Development

Pediatrician, allergies, medications, and the routines and preferences that help us support your child from day one.

Subsections3.1 — 3.2
ConfidentialReviewed By Director
RequiredImmunizations Before Day One

Health & Medical

3.1 · Health and Medical Information

Care providers, conditions, and what we need on file.

Pediatrician Or Healthcare Provider
Practice Or Clinic Name
Practice Phone
Practice Address
Health Insurance Provider
Policy Or Member ID
Allergies (Food, Environmental, Medication)
Current Medications
Required Form
A separate Medication Authorization is required for any medication administered at school.
Ask the director for the form. Medication cannot be administered without it.
Medical Conditions, Diagnoses, Or Special Health Considerations
Individualized Family Service Plan (IFSP) Or Individualized Education Plan (IEP)
Required Before Day One
Up-to-date immunization records must be on file before enrollment begins.
Please confirm one of the following:

Background & Development

3.2 · Knowing Your Child

A few questions so we can welcome your child the way you would.

All responses are confidential and used only to support your child's care.

Languages Spoken At Home
Has Your Child Previously Attended An Early Education Program?
How Does Your Child Respond To New Environments Or Transitions?
Current Sleep Habits And Nap Schedule
Eating Habits, Mealtime Preferences, And Considerations
Words, Phrases, Or Signals Your Child Uses To Communicate Needs
Activities, Toys, Or Routines Your Child Enjoys Most
Anything Else You Would Like Our Teachers To Know
Chapter Four
04

Agreements & Signatures

The policies you are agreeing to, how you found us, and the signatures that complete your enrollment.

Subsections4.2 — 4.4
InitialEach Acknowledgment
SignBoth Parents Where Applicable

Agreements & Acknowledgments

4.2 · Required Acknowledgment

Please confirm and initial below.

  1. I confirm that all information provided in this enrollment form is true, accurate, and complete to the best of my knowledge.
    Initial

How Did You Hear About Us?

4.3 · Referral Source

One brief question before you sign.

Word Of Mouth — Who Referred You
Other

Family Signature

4.4 · Final Signature

Please sign and date below.

By signing below, I confirm that all information provided in this form is accurate and complete. I agree to notify ENLA Learning of any changes to the information above in a timely manner.

Primary Parent Or Guardian — Print Name
Date
Primary Parent Or Guardian — Signature

Draw your signature with your finger, stylus, or mouse.

Secondary Parent Or Guardian — Print Name (Optional)
Date
Secondary Parent Or Guardian — Signature

Optional — leave blank if not applicable.

For Office Use Only
Date Received
Application Fee
Registration Fee
Program Confirmed
Start Date Confirmed

Education Nation Learning Academy
1942 N. Front Street, Philadelphia, PA 19122 · (800) 327-7674 · hello@enlalearning.com
A Montessori-inspired learning community.