Sonshine Center

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About the Student

Name

First

Middle

Last

Suffix

Preferred Name

Gender

Date of Birth/Due Date

mm/dd/yyyy

Academic Year

Program Interested In

Please select the appropriate program for your child based on their age below.

Please select your child's current grade below.

Please select your child's rising grade below.

Class/Grade

Days Interested In

Time of Day

Before/After School Program Interest

Before School Days Interested In

After School Days Interested In

Is the schedule flexible?

Yes No

Primary Household

Primary Home Address

First Parent or Guardian in Primary Household

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone

Type

Number

Secondary Phone

Type

Number

Primary Email

Employment Information

Employment Status

Title/Occupation

Employer

Business Phone

Business Address

Financial Responsibility

Is this parent/guardian financially responsible for the student?

Yes No

What percentage?

Second Parent or Guardian in Primary Household

Is there a second parent or legal guardian in this household?

Yes No

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone

Type

Number

Secondary Phone

Type

Number

Primary Email

Employment Information

Employment Status

Title/Occupation

Employer

Business Phone

Business Address

Financial Responsibility

Is this parent/guardian financially responsible for the student?

Yes No

What percentage?

Additional Guardianship Information

Does the student have an additional household with legal guardianship?

Yes No

Additional Home Address

Primary Parent or Guardian in Household

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone

Type

Number

Secondary Phone

Type

Number

Primary Email

Employment Information

Employment Status

Title/Occupation

Employer

Business Phone

Business Address

Financial Responsibility

Is this parent/guardian financially responsible for the student?

Yes No

What percentage?

Second Parent or Guardian in Household

Is there a second parent or legal guardian in this household?

Yes No

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone

Type

Number

Secondary Phone

Type

Number

Primary Email

Employment Information

Employment Status

Title/Occupation

Employer

Business Phone

Business Address

Financial Responsibility

Is this parent/guardian financially for the student?

Yes No

What percentage?

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