Enrollment Application
              Creative Learning Center



____________________________________     ______  _______
Name of Child                              Male   Female

____/____/____                       ___________________
Date of Birth                        Age as of Sept. '03

________________________________________________________
Address

________________________________________________________
City, State, Zip

________________________________________________________
Home Phone

________________________________________________________
Business Phone

________________________________________________________
Father's Name/Occupation

________________________________________________________
Mother's Name/Occupation

________________________________________________________
Previous Group or School Experience

________________________________________________________
Referred to Creative Learning Center (CLC) By

________________________________________________________
List Relatives of Applicant Currently Attending CLC


Parents' Marital Status:
_________   _________   _________   _________  _________
Married     Separated   Divorced    Widowed    Single

Are there custody orders in effect regarding this child?
Yes_________         No_________


If my child is enrolled in CLC, I agree to abide by all
Parent Handbook guidelines. Each child must be accepted
for each year. Prior CLC enrollment does not guarantee
acceptance. Acceptance is only by the affirmative act of
CLC. I have read this form in it's entirety and fully
understand it. I certify that the foregoing statments are
true to the best of my knowledge and that any willful
omission or an misrepresentation of the information on
this form will be considered grounds for removal of this
application from consideration by CLC.

___________________________________   _________________
Signature                             Date


                    Sessions

Please clearly check your desired sessions.


Nursery School: Morning and Afternoon
              1st Preference      2nd Preference
              Days                Days

___3 Mornings _______________     ________________
 (9:00-11:45)

___3 Afternoons (Mon, Wed, Fri)

___4 Mornings _______________     ________________

___5 Mornings


Primary Learning Community (9:00-2:30)

___5 Full Days Per Week


Enrichment Classes (11:45-2:30)

___Enrichment A (Tues, Thurs)

___Enrichment B (Tues, Thurs)

___Enrichment C (Mon, Wed, Fri)

___Enrichment D (Tues, Thurs)


Early Birds (8:30-9:00)

___I'm interested in using this service on a regular basis.


Prime Time After School Program (2:30-5:30)

___I'm interested in using this service on a regular basis.


Mail this to:
Creative Learning Center
160 Avenue of the Commons
Shrewsbury, NJ 07702

Please enclose a $15 non-refundable application fee.
The fee must accompany this application.