Frederick Country Day Application
Please print & complete the form below and return it to the center with a check for $50.00.
Frederick Country Day Application
Please print & complete the form below and return it to the center with a check for $50.00.
| First | Middle | Last |
| Birth Date __________________ | Toilet Trained | _______ yes _________ no _________ working on it! |
| Child's Home Address | __________________________________________________________ |
| __________________________________________________________ |
Home Telephone _______________________________________ Preferred
Enrollment Date ____________
Hours and Days of Enrollment Requested_____________________________________________________
Mother's Name ______________________________________ Work Phone ________________________
Father's Name ______________________________________ Work Phone _________________________
Parent's Marital Status _____________________________________________
Siblings (names & ages) ___________________________________________________________________
______________________________________________________________________________________
Medical Conditions/Special Needs (allergies, asthma, etc.) _________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
How did you learn of Frederick Country Day? ___________________________________________________
______________________________________________________________________________________
Why have you chosen Frederick Country Day? __________________________________________________
______________________________________________________________________________________
What are your expectations? ________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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Frederick Country Day - 1601 Wheyfield Drive - Frederick,
Maryland 21701 - 301-694-7000