White Clay Learning Center
120 Rose Hill Ave.
West Grove PA 19390

(610) 274-8031

Application for Admission

Applicant

Parent or Guardian

Name
Address
City State Zip	,
Home telephone
Business phone
email

Additional Parent or Guardian, if any

Name
Check if same address	same as first parent/guardian
Address
City State Zip	,
Home telephone
Business phone

Child

Name
Check if same address	same as first parent/guardian
Address
City State Zip	,
Birth date
Gender	Select one Female Male
Telephone

Child's medical information
Child's interests
My child is well-studied in the following subjects (no answer is required or expected):

Material fee

There is an annual materials fee ($125.00 per child in K - 3; $150 per child in grades 4 - 8). The fee is due with your application. If space is available, this fee will also secure your child’s place on our enrollment. 

	I am sending a check by US Postal Service
	Other