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Academic Year (YYYY / YYYY)

What would be your ideal start date?

Child's Name

Date of Birth

Place of Birth

Family Mail Address

City

Zip Code

Guardian 1

Mother

Father

First and Last Name

Cell Number

Email Address

Employer

Business Number

Home Phone Number

Guardian 2

Mother

Father

First and Last Name

Cell Number

Email Address

Employer

Business Number

Home Phone Number

Does Your Child Speak French?

Yes

Do Parents Speak French?

Yes, One parent

Yes, Both parents

None

What is the first language spoken at home?

What is the second language spoken at home, if any?

PLEASE CHOOSE BELOW A SCHEDULE AND TIME FOR THE ACADEMIC YEAR, SEPTEMBER - JUNE

5 Days a Week: Monday - Friday
3 Days a Week: Monday, Wednesday, Friday
2 Days a Week: Tuesday, Thursday

Full Day: 8:00 am - 3:00 pm
Full Day + Enrichment: 8:00 am - 6:00 pm
Enrichment only: 3:00 pm - 6:00 pm

Petits Poussins Midtown is not permitted to administer any medication, if needed, please do so at home or after school.

I (we) authorize staff and Director of Petits Poussins Midtown to obtain all necessary Emergency Medical treatment, in case of an emergency.

Additional Questions

Have you been on a school tour of Petits Poussins Midtown?

Yes Yes

Where/how did you hear about our school? (Please select one or more options below)

Another website (e.g., French Morning Media, Mommy Poppins, etc.)
Google Search
Google Maps
Facebook Ad
Word of Mouth
Outside School Posters/Signage
I walked by the school
Other: (Please specify)

Would you like to share any additional information about your child or family with us? (Please feel free to include any relevant details.)

New York department of health requires that all children are vaccinated for school entrance.

Do you vaccinate your child?

Yes No

I, hereby, authorize Petits Poussins Midtown to provide care for my child.

I declare to the best of my knowledge that all statements made in this application are true.

First and Last Name (Guardian 1)

First and Last Name (Guardian 2)

Date

Amount

Payment For

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