SUPER KIDS’ PLACE (SKP) ENROLLMENT FORM Child's Name Date of Birth Sex Parent’s Status: Single Married Divorced Separated Is there a separation or divorce custody issue of which the staff should be aware? Child’s Information: Other siblings in the home Name Date of Birth Enrolled in Program? Does your child have any allergies or food dislikes? How does your child get along with other children? Are there any physical, emotional, or disability issues your child is being treated for? Does your child take any daily prescribed medications? If so, what and when? Does your child have special needs or an IFSP/IEP that we should be aware of? If so, would you like to provide us all or part of the IFSP/IEP? Is there any other information about your child you believe will be helpful to the staff in understanding? and caring for your child? Mail to school of enrollment. Address found on contact page.
