Midtown Atlanta: (404) 541-0700 Eagles Landing Stockbridge: (770) 389-9393 Stone Mountain: (770) 465-3434 Home Contact Us Schedule a Tour Our Centers Locations Midtown Eagle’s Landing Stone Mountain ABC Early Learning Blog Programs Infant Daycare Program – Baby Bugs Young Toddler Daycare Program –Tiny Turtles Older Toddler Daycare Program – Bumblebees Preschool Program – Caterpillars Georgia Pre-K Program – Butterflies After school program Summer Camp Program Parent’s Corner Pay Tuition PreK Enrollment Forms Parent’s Portal Login-UNDER CONSTRUCTION Password Reset Edit Parent Portal Profile Online Viewing-UNDER CONSTRUCTION Careers Enroll Now Career Opportunities Pre-K Registration Form: School Location Please select the school you would like to enroll into: Choose OneMidtownEagle's Landing Child Information Child's Last Name Child's First Name Child's Middle Name Child's Name Suffix: (i.e. Jr, Sr, II,III) Child's Social Security Number Child's Date of Birth (MM/DD/YYYY) Sex MaleFemale Home Street Address County City Zip Code Phone Number (i.e. 555 555 5555) If the Student is transferring from another Pre-K, please provide the following: Previous School Name Last Date in Attendance ( MM/DD/YYYY ) Parent Guardian Information Parent/Guardian #1 Information Parent #1 Last Name Parent #1 First Name Parent 1 Middle Initial Please note - you only need to enter the address if it is different from the child Home Street Address for Parent #1 City for Parent #1 State for Parent #1 Zip Code for Parent #1 Phone Number for Parent #1 Cell Phone Number for Parent #1 Email Address for Parent #`1 Place of Employment for Parent #1 Work Phone Number for Parent #1 Work Address for Parent #1 Work City for Parent #1 Work State for Parent #1 Work Zip Code for Parent #1 Parent/Guardian #2 Information Parent/Guardian#2 Last Name Parent/Guardian#2 First Name Parent/Guardian #2 Middle Initial Parent/Guardian #2 Phone Number Parent/Guardian #2 Cell Phone Number Parent/Guardian #2 Email Address Home Address If different from child Parent/Guardian #2 City Parent/Guardian #2 State Parent/Guardian #2 Zip Code Parent/Guardian #2 Place of Employment Parent/Guardian #2 Work Phone Number Parent/Guardian #2 Work Address Parent/Guardian #2 Work City Parent/Guardian #2 Work State Parent/Guardian #2 Work Zip Emergency Contact Information Emergency Contact #1 Emergency Contact #1 Name and Relationship Emergency Contact Cell Phone Number Emergency Contact Alternate Phone Number Emergency Contact Email Address Emergency Contact #2 Emergency Contact #2 Name and Relationship Emergency Contact #2 Cell Phone Number Emergency Contact #2 Alternate Phone Number Emergency Contact #2 Email Date You Plan to Sign This Document ( MM/DD/YYYY) Note - enter today if you are unsure Child Maintenance Information: Child's Living Arrangements: BOTH PARENTSFATHERMOTHEROTHER Child's Legal Guardian BOTH PARENTSFATHERMOTHEROTHER The child may be released to the person(s) signing this agreement or to the following people: Person #1 your child can be released to Name and Address of Person #1: Relationship and Cell Phone Number of Person #1 Person #2 your child can be released to Name and Address of Person #2: Relationship and Cell Phone Number of Person #2 Person #3 your child can be released to Name and Address of Person #3: Relationship and Cell Phone Number of Person #3 Person #4 your child can be released to Name and Address of Person #4: Relationship and Cell Phone Number of Person #4 Health Information: Child's Physician or Clinic's Name (Child's Primary Health Source) Date of Last Full Health Screening Clinic's Number My child has the following special needs: Enter any additional needs below Enter any additional needs below The following special accomodation(s) may be required to most effectively meet my child's needs while at this center: Enter any additional accomodations below: Enter any additional accomodations below: If your child is currently on medication(s) prescribed for long-term continuous and/or has any pre-existing allergies, illness, or health concerns: please enter them below. Enter any additional medications , allergies, conditions, illnesses or health concerns below Enter any additional medications , allergies, conditions, illnesses or health concerns below Please leave this field empty. FollowFollowFollow © Copyright ABC Early Learning Academy Inc. 2018