Enrollment Form - Steele Cooperative Preschool

Enrollment Form

Child Information

Child's Full Name

(first middle last)

Child's Date of Birth

Child's Gender

Male

Female

Non-Binary

Other

Explain other or anything else you would like us to know about your child's gender

Does your child have any allergies?

Yes

If your child has allergies list them here

Does your child's allergy require an Epi pen?

Yes

N/A

Class

The following information is for grant reporting only and is confidential. Steele Cooperative Preschool is a non-profit organization and applies for grants to help with scholarships that are offered to qualified Steele families. These grants often require demographic information on our school. If your family needs tuition assistance please check out the scholarship page on our website (https://steelecooperativepreschool.org/scholarship-application/).

Select Income

Parent/Guardian Information

The first parent listed is required to be an emergency contact, authorized pickup person, and receive emails. List parents in order you would like to be contacted in an emergency.

Parent's Name

(First Last)

Relationship to child

Emergency Contact AND Pickup Authorization

At least 1 parent is required to be an emergency contact and authorized to pick up your child

Street Address

City

State

Zip Code

I would like to receive email correspondence from Steele

At least 1 parent is required to receive emails

Primary Phone

XXX-XXX-XXXX

Secondary Phone

XXX-XXX-XXXX (optional)

Employer Information

Occupation

Do you have employer information to enter?

Yes

Employer

Employer Street Address

City

State

Zip Code

Work Phone

XXX-XXX-XXXX

Additional Parent/Guardian Information

Does your child have another Parent/Guardian?

Yes

No, only 1 Parent/Guardian

Parent's Name

(First Last)

Relationship to child

Emergency Contact AND Pickup Authorization

Pickup Authorization ONLY

Neither

If you select the 2nd or 3rd option please talk to your teacher about your situation

Street Address

City

State

Zip Code

I would like to receive email correspondence from Steele

Primary Phone

XXX-XXX-XXXX

Secondary Phone

XXX-XXX-XXXX (optional)

Employer Information

Occupation

Do you have employer information to enter?

Yes

Employer

Street Address

City

State

Zip Code

Work Phone

XXX-XXX-XXXX

Child's Physician

Physician's Name

(First Last)

Street Address

City

State

Zip Code

Physician's Phone

XXX-XXX-XXXX

Child's Dentist

Dentist's Name

(First Last)

Street Address

City

State

Zip Code

Dentist's Phone

XXX-XXX-XXXX

Child's Hospital

Do you have a preferred hospital?

No, use the hospital closest to school

Yes (fill out hospital information below)

More Emergency Contacts and/or Pickup Authorizations

These are in addition to Parents/Guardians listed above (you do not need to list the Parents/Guardians again). You need at least one additional Emergency Contact. Please note that Emergency Contacts also need to be authorized to pick up your child.

Person #1

Emergency Contact AND Pickup Authorization

At least 1 additional person is required to be an emergency contact and authorized to pick up your child

Name

(First Last)

Relationship to Child

Street Address

City

State

Zip Code

Primary Phone

XXX-XXX-XXXX

Secondary Phone

XXX-XXX-XXXX (optional)

Person #2

Emergency Contact AND Pickup Authorization

Pickup Authorization ONLY

Name

(First Last)

Relationship to Child

Street Address

City

State

Zip Code

Primary Phone

XXX-XXX-XXXX

Secondary Phone

XXX-XXX-XXXX (optional)

Person #3

Emergency Contact AND Pickup Authorization

Pickup Authorization ONLY

Name

(First Last)

Relationship to Child

Street Address

City

State

Zip Code

Primary Phone

XXX-XXX-XXXX

Secondary Phone

XXX-XXX-XXXX (optional)

Person #4

Emergency Contact AND Pickup Authorization

Pickup Authorization ONLY

Name

(First Last)

Relationship to Child

Street Address

City

State

Zip Code

Primary Phone

XXX-XXX-XXXX

Secondary Phone

XXX-XXX-XXXX (optional)

Payment*

Yes I understand

I understand that I must make monthly tuition payments. PAYMENTS can be made via check submitted to the school or online: https://steelecooperativepreschool.org/payments

Total Students Enrolled at steele

Classes Available

1:6(or less) adult to child ratio

Years EstablishEd

Get In Touch

Location: 3746 Grove St, Denver, CO 80211
Telephone: (303) 433-0832

School Hours:
Tadpoles 9:00 am – 11:00 am (Tuesday and Thursday)
Polliwogs 9:00 am – 11:30 am (Monday, Wednesday, Friday)
Frogs 12:00 pm - 3:00 pm (Monday, Tuesday, Wednesday, Thursday)

Child Information

Parent/Guardian Information

Employer Information

Additional Parent/Guardian Information

Employer Information

Child's Physician

Child's Dentist

Child's Hospital

More Emergency Contacts and/or Pickup Authorizations

These are in addition to Parents/Guardians listed above (you do not need to list the Parents/Guardians again). You need at least one additional Emergency Contact. Please note that Emergency Contacts also need to be authorized to pick up your child.

Person #1

Person #2

Person #3

Person #4

CLASSES

Tadpoles (2 – 3 years)

Polliwogs (3 – 4 years)

Frogs (4 – 5 years)

Total Students Enrolled at steele

Classes Available

1:6(or less) adult to child ratio

Years EstablishEd

Get In Touch

School Hours:
Tadpoles 9:00 am – 11:00 am (Tuesday and Thursday)
Polliwogs 9:00 am – 11:30 am (Monday, Wednesday, Friday)
Frogs 12:00 pm - 3:00 pm (Monday, Tuesday, Wednesday, Thursday)

Child Information

Parent/Guardian Information

Employer Information

Additional Parent/Guardian Information

Employer Information

Child's Physician

Child's Dentist

Child's Hospital

More Emergency Contacts and/or Pickup Authorizations

These are in addition to Parents/Guardians listed above (you do not need to list the Parents/Guardians again). You need at least one additional Emergency Contact. Please note that Emergency Contacts also need to be authorized to pick up your child.

Person #1

Person #2

Person #3

Person #4

CLASSES

Tadpoles (2 – 3 years)

Polliwogs (3 – 4 years)

Frogs (4 – 5 years)

Total Students Enrolled at steele

Classes Available

1:6(or less) adult to child ratio

Years EstablishEd

Get In Touch

School Hours: Tadpoles 9:00 am – 11:00 am (Tuesday and Thursday)Polliwogs 9:00 am – 11:30 am (Monday, Wednesday, Friday)Frogs 12:00 pm - 3:00 pm (Monday, Tuesday, Wednesday, Thursday)

School Hours:
Tadpoles 9:00 am – 11:00 am (Tuesday and Thursday)
Polliwogs 9:00 am – 11:30 am (Monday, Wednesday, Friday)
Frogs 12:00 pm - 3:00 pm (Monday, Tuesday, Wednesday, Thursday)