Child's Name *

First Name

Last Name

Current Glenn Student *

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birth Date *

MM

DD

YYYY

For Toddler's only

Applying for:

Tues/Thurs

Wed/Fri

No Preference

For 2's only

Applying for:

2 day 2's

3 day 2's

Sex *

Male

Female

Parent(s) Live at the Same Address as Child *

If the primary caretaker lives at the address entered above, please select "Yes." If a primary caretaker lives at a secondary address, please enter their information below. Please enter primary caretakers name below, regardless of address.

Yes

No

Parent 1 Name *

First Name

Last Name

Parent 1 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent 1 Cell Phone *

(###)

###

####

Parent 2 Name

First Name

Last Name

Parent 2 Address

Only fill out if this is different from Child/Parent's address above.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent 2 Cell Phone

(###)

###

####

Check all that Apply *

Current Glenn School Family

Glenn Memorial UMC Member

Emory University Employee

Other

All Glenn School for Young Children families are expected to volunteer for a minimum of six (6) hours throughout the year. Options for volunteering include: Glenn Gala Auction, Transportation City, Family Day, and other events. *

Agree

I understand that my advance tuition payment and application fees are non-refundable. *

Agree

Is your child potty trained? *

Children in the 3s class and higher are required to be potty trained or actively training.

Yes

No

Actively Training