Are you considering applying for enrollment at Richland, but not sure where to start? Don't worry – we've got you covered! This blog post will walk you through the necessary steps to fill out a successful Richland application for enrollment form. We'll provide helpful tips and discuss important aspects of the application process so that your submission is quick and simple. By taking the time to do it right, you can be one step closer to joining the dynamic community here at Richland!
Question | Answer |
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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
Last |
First |
RCC ID # |
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Home Address |
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City |
State |
Zip |
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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 |
Zip |
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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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Is |
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
Last |
First |
Relationship to Child |
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Street Address |
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City |
State |
Zip |
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Home Phone |
Cell Phone |
Work Phone |
Last |
First |
Relationship to Child |
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Street Address |
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City |
State |
Zip |
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Home Phone |
Cell Phone |
Work Phone |
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 |
Date |
Signature of Director |
Date |
Signature of Parent/Guardian |
Date |