Application

Preschool, Kindergarten, Camps, and toddler/child Classes

If you are applying for our preschool or kindergarten program and have not yet inquired about availability, please fill out the Inquiry form first.

To apply for a Hummingbirds Nest Collaborative program, camp, or toddler/child class, please fill out and click the submit button for each of the four forms below. You must fill out all four forms in order for your application to be complete and processed.

Please note, you will need emergency contacts, doctor contact, child's medications, and health insurance information to complete these forms. It would be best to gather this information before you start as you will not be able to save forms in progress. 

A "pen and ink" version of these forms can be downloaded here.

1. General Information Form

Child's Name *
Child's Name
Date of Birth *
Date of Birth
Program applying for: *
Parent/Guardian Name 1 *
Parent/Guardian Name 1
Phone *
Phone
Parent/Guardian Name 2
Parent/Guardian Name 2
Phone
Phone
Child's Address *
Child's Address
Is your child fully potty-trained? *
Was your child nursed or bottle fed? *
Who does your child live with? *
Please check all that apply.
Please contact us to provide any documentations that would help support the staff’s knowledge on how to best serve your child.
Photograph Waiver: *
By checking the box below, I understand and agree to the following:
Please enter your full first and last name below. By entering your name you agree to and understand the above statements.
Date *
Date
 

2. General Emergency Form

Child: *
Child:
Date of Birth *
Date of Birth
Address *
Address
Home Phone *
Home Phone
Please write "none" if your child does not have any medical conditions.
PARENT/GUARDIAN 1
Parent/Guardian Name 1 *
Parent/Guardian Name 1
Cell Phone (or main phone) *
Cell Phone (or main phone)
Work Phone *
Work Phone
PARENT/GUARDIAN 2
Parent/Guardian Name 2 *
Parent/Guardian Name 2
Cell Phone (or main phone) *
Cell Phone (or main phone)
Work Phone *
Work Phone
 

3. Emergency & Authorized Pick Up Contacts

Child's Name *
Child's Name
Date of Birth *
Date of Birth
EMERGENCY CONTACTS
Please list people who can be reached during session hours and are as close as possible.
Emergency Contact Person 1 *
Emergency Contact Person 1
Phone *
Phone
Emergency Contact Person 2 *
Emergency Contact Person 2
Phone *
Phone
Emergency Contact Person 3 *
Emergency Contact Person 3
Phone *
Phone
PERSON(S) AUTHORIZED TO PICK UP MY CHILD:
Authorized Pick Up Person 1 *
Authorized Pick Up Person 1
Phone *
Phone
Authorized Pick Up Person 2 *
Authorized Pick Up Person 2
Phone *
Phone
Authorized Pick Up Person 3 *
Authorized Pick Up Person 3
Phone *
Phone
 

4. Medical and Disaster Emergency Form

Child's Name *
Child's Name
Date of Birth *
Date of Birth
Child's Doctor *
Child's Doctor
Doctor Phone *
Doctor Phone
Doctor Address
Doctor Address
Please write "none" if your child does not take any medication.
Medical Authorization: *
By checking the box below, I agree to and understand the following.
Authorization to dispense non-prescription medications: I, as parent or guardian, I hereby authorize the designated school personnel to dispense the following over-the-counter medication(s) to my child. *
Please select all that apply or None.
Date *
Date
IN CASE OF AN EARTHQUAKE OR NATURAL DISASTER:
Please tell us where your family will gather if there is an earthquake or natural disaster:
Planned Family Evacuation Address: *
Planned Family Evacuation Address:
Planned Family Evacuation Phone: *
Planned Family Evacuation Phone:
Out-of-state contact in case of earthquake: *
Out-of-state contact in case of earthquake:
These may be the same as emergency contacts, but please fill them in here anyway:
Phone *
Phone
Local contact in case of earthquake: *
Local contact in case of earthquake:
These may be the same as emergency contacts, but please fill them in here anyway:
Phone *
Phone