Horace Mann/Leet Center Application (New Child)

Please complete a separate application for each child.

Please note: If you do not receive a confirmation email regarding your child's application within one month, please contact the office.

* indicates required fields

*Application Type:
- Select - Infant (12-24 months) Toddler (24-35 months) Pre-School (3-5 years) Elementary (Kindergarten-6th)

*Desired Starting Date:

Child Information

*First Name:

*Last Name:

*Birthdate:

*Enrollment Status: (for office use only)

*Homeroom: (for office use only)

Parent/Guardian

*First Name:

*Last Name:

*Email Address:

*Primary Phone:

Associations

If yes, Sibling Name:

Acknowledgements

*Legal Signature of Parent/Guardian: