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INTERESTED IN ENROLLING
?
Fill the following out to get started:
Please complete this form only
AFTER
you have toured our facility.
Harmon Oaks will not share your personal information with any third party. We will ONLY use the information you provide to establish initial contact with your family.
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Indicates required field
Parent
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First
Last
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Email
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Parent
*
First
Last
Email
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Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Parent 1 - Profession / Place of Work
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Parent 2 - Profession / Place of Work
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How did you hear about us?
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Friend / Family
Online Search Engine
Street Sign
Neighborhood Publication
Social Media
Other
If Friend/Family or Other please specify:
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Child's Name
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First
Last
Program of Need:
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Seedlets Program (Young Toddler 18mon-30mon)
Sprouts Program (Transitional Preschool)
Bloomers Program (Children turning 3 by July 1st, prior to the intended school year)
BlosomsProgram (3 1/2 to 5 years of age)
Child's Date of Birth
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Location/Facility of Interest
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Harmon Oaks Lake Balboa
Harmon Oaks NoHo West
First Available- Lake Balboa & NoHo West
Enrolling in Part or Full Time Program?
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Part Time
Full Time
I would be willing to enroll my child full-time, should a part time seat not be available? I'd like to be on the waitlist for both options.
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Yes
No
How soon are you hoping to enroll your child in a nursery school program?
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As soon as possible!
1-2 months
3-5 months
6 + months
Pregnant & hoping to reserve infant care
How is your child cared for presently? If in a center or daycare, please name/where presently enrolled.
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Briefly explain why you are looking to begin/change your child's day setting?
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What are some areas of development & growth you'd like us to support in your child's early care & education?
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Describe your little one to us in one paragraph. Tell us about his/her "loves" and interests, personality, as well as, temperament and relationship with family members at home. You may be as brief or as thorough as you wish.
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Questions or further information you'd like to share with us (CCRC support, lunch program, special needs, dietary needs, etc.):
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How/why do you feel Harmon Oaks is the right fit for your family and for your child?
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Has your child experienced any developmental difficulties or delays (speech, gross motor skills, fine motor skills, language, physical impairments, emotional / social) which we would closely evaluate and support?
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Date Attended Open House and/or Tour:
*
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