Schedule a Tour of SMMS

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home/Cell Phone *

(###)

###

####

Work Phone

(###)

###

####

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home/ Cell Phone *

(###)

###

####

Work Phone

(###)

###

####

Name *

First Name

Last Name

Potty trained? *

yes

no

Child's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender *

male

female

Birthday *

MM

DD

YYYY

Is your child up to date on immunizations? *

yes

no

Does your child receive any of the following? *

Please check all that apply

IEP

ISP

Occupational Therapy

Speech Therapy

ABS

None

A photograph will be taken of your child for security purposes to be maintained in our database. *

I consent

I do not consent

Permission is granted to use pictures of your child in school materials such as the website or brochures. *

I consent

I do not consent

Permission is granted to take pictures of your child for school events/ to post in the classroom. *

I consent

I do not consent

Who will be responsible for making tuition payments and/or fees? *

First Name

Last Name

Scheduled Check-In Time *

For children below the age of 2 years, we provide a 4 day program (Mon to Thu, or Tue to Fri), and 5-day program (Mon- Fri). If a child is dropped off earlier or picked up after the time agreed upon, there will be an early drop off/ late pick up fee.

I agree with & understand the information stated above.

Registration and Waitlist fees are non-refundable and non-transferable across our schools. *

If you decide to enroll in our program or join our waitlist, you are required to pay a non-refundable & non-transferable registration or waitlist fee to secure your child's spot.

Yes, I understand and acknowledge that all Registration and Waitlist fees are non-refundable and non-transferable.

Waitlist *

If your child is on our waitlist and we call to offer you a spot, there is a 30 day window for your child to start. If you decline the spot, then your child will be removed from the waitlist. If you wish to keep them on the waitlist after we have offered a spot, then the waitlist fee is payable again.

Check to acknowledge policy

Parent Name serving as signature *

First Name

Last Name

Today's Date *

MM

DD

YYYY