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Academic Year (YYYY / YYYY)
Please Enter Academic Year Here
What would be your ideal start date?
Please Enter Ideal Start Date Here
Child's Name
Please Enter Child's Name Here
Date of Birth
Please Enter Date of Birth Here
Place of Birth
Please Enter Place of Birth Here
Family Mail Address
Please Enter Family Mail Address Here
City
Please Enter City Here
Zip Code
Please Enter Zip Code Here
Guardian 1
Mother
Father
Please Choose an option
First and Last Name
Please Enter Guardian Name Here
Cell Number
Please Enter Cell Number Here
Email Address
Please Enter Email Address Here
Employer
Business Number
Home Phone Number
Guardian 2
Mother
Father
Please Choose an option
First and Last Name
Please Enter Guardian Name Here
Cell Number
Please Enter Cell Number Here
Email Address
Please Enter Email Address Here
Employer
Business Number
Home Phone Number
Does Your Child Speak French?
Yes
No
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 a schedule and time for the academic year (September - June)
Select Days
5 Days a Week:
Monday - Friday
3 Days a Week:
Monday, Wednesday, Friday
2 Days a Week:
Tuesday, Thursday
Select Time
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
Additional Questions
Have you been on a school tour of Petits Poussins Midtown?
Yes
No
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.
Please Check if you agree
I declare to the best of my knowledge that all statements made in this application are true.
Please Check if you agree
First and Last Name (Guardian 1)
Please Enter Name Here
First and Last Name (Guardian 2)
Date
Date
Amount
$
Please provide a valid amount.
Payment For
APPLICATION: ONE-TIME FAMILY FEE [$200.00]
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Have a Coupon or Voucher Code?
Code
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.
Card Number
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Name on Card
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Expiry Date
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Security Code
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Total:
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