To ensure a space, or to be placed on our waiting list, complete this application and return with your non-refundable registration fee ($100 for the 1st child, $50 per sibling).

Please fill in all required fields.

Child's Information

Last Name

First Name

Middle Name

Street Address

City/State

Zip Code

Home Phone

Birth Date

Gender M F

Enrolling Parent/Guardian

Last Name

First Name

Middle Initial

Relationship to Child

Home Address

City/State

Zip Code

Email Address

Home Phone

Cell Phone

Employer

Work Phone

Pager

Enrollment Information

Start Date

Select School Location Aurora School Western Reserve School (Streetsboro)

Days of the Week Monday Tuesday Wednesday Thursday Friday

Extracurricular (check all that apply) Dance Spanish Tutoring (Math and/or Language Arts)

After School Club (choose one) Morning only Afternoon only Morning & Afternoon

How did you hear about us? Website Front sign Newspaper Friend Other


Payment Method Check Credit Card

Billing First Name

Billing Last Name

Billing Address

Credit Card Number

Expiration Date (MMYY)

Security Code