The Richland Application For Enrollment form plays a pivotal role in the admissions process at the Adele P. Glen Academy for Early Childhood Education at Richland Community College, located in Decatur, Illinois. This comprehensive document is designed to collect essential information about prospective students and their families, ensuring that the needs and safety of each child are meticulously addressed. It begins with basic details about the child, including name, birthdate, and sex, before delving into more in-depth information regarding the parent or guardian, which encompasses contact information, employment details, and identification numbers. The form also seeks to identify the primary custodians of the child and addresses the accessibility of the non-custodial parent, if applicable. Emergency contacts and a preferred physician are requested to guarantee that the academy can respond effectively in urgent situations. Health-related queries cover a broad spectrum, from medical conditions and physical handicaps to dietary preferences and allergies, aiming to cater to each child's specific needs and well-being. This form also inquires about the child's behavior, including fears, toilet training status, and any special terminology they use for everyday objects. Additionally, it allows parents or guardians to specify their preferred program option in terms of the number of days per week, ensuring a fit that is most beneficial for the child's development and the family's schedule. Signed consent from the parent or guardian, alongside the director's endorsement, finalizes the application, emphasizing the collaborative nature of the enrollment process and underscoring the academy's commitment to confidentiality and the protection of personal information provided by the families.
| Question | Answer |
|---|---|
| Form Name | Richland Application For Enrollment Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | enrollment_app college application to print form |
Application for Enrollment
The Adele P. Glen Academy for Early Childhood Education Academy
Richland Community College | One College Park | Decatur, Illinois 62521
Date
All information is confidential. We cannot share in any information you provide without your written permission.
Child’s Name |
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First |
M.I. |
Birthdate |
Sex |
Parent/Guardian’s Information
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RCC ID # |
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Home Address |
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State |
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Home Phone |
Cell Phone |
Work Phone |
Place of Employment
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First |
RCC ID # |
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Home Address |
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State |
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Home Phone |
Cell Phone |
Work Phone |
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Place of Employment |
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Primary Custodian/s: Mother |
Father |
Legal Guardian |
Married Parents |
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Yes |
No |
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If yes, list name of |
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Emergency Contacts
Please list two people to contact if Parent/Guardian cannot be reached
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First |
Relationship to Child |
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Street Address |
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Home Phone |
Cell Phone |
Work Phone |
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First |
Relationship to Child |
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Street Address |
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State |
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Home Phone |
Cell Phone |
Work Phone |
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Physician to Contact
Physician’s Name |
Phone Number |
Address |
Hospital or Clinic |
Health of Child
Please explain any of the following that concern your child. Mark ”no” or ”none” if your child does not have any of the below conditions.
Do not leave blank.
Medical Conditions
Physical Handicaps
Restrictions for Play
Allergies
Asthma
Food Likes
Food Dislikes
Fears
Is your child toilet trained? Yes No
Does your child have special names for common objects? (potty, cookies, drinks, etc.)
Does your child take medications regularly? |
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If so, what kind and frequency |
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Other information that you feel would be helpful
What program option are you interested in? |
5 days a week |
3 days a week 2 days a week |
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Parent/Guardian Signature |
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Signature of Parent/Guardian |
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Signature of Director |
Date |
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Signature of Parent/Guardian |
Date |