ELRA Enrollment Form

Parents to apply for Pre-School Program Camden City Residents  click here.

Parents to apply for Infant and Toddlers Program, and NON-Camden residents.  Please fill out application below.

    Child Info

    Child's Name

    Date of Birth

    Age as of 10/19

    Gender M/F

    Primary Language Spoken at Home

    Current/Previous Pre-School Provider

    Child's Name

    Date of Birth

    Age as of 10/19

    Gender M/F

    Primary Language Spoken at Home

    Current/Previous Pre-School Provider

    Child's Name

    Date of Birth

    Age as of 10/19

    Gender M/F

    Primary Language Spoken at Home

    Current/Previous Pre-School Provider

    Parent/Guardian Info

    Father's Name

    Father's Country of Origin

    Mother's Name

    Mother's Country of Origin

    Who does your child live with?
    Mother and FatherMotherFatherGrandparentsGuardianOther

    If "Guardian" or "Other," please specify:

    Student(s) Address:

    Home Phone Numbers

    Work Phone Numbers

    Cell Phone Numbers

    Sibling Info

    Do you currently have a Sibling(s) attending LEAP Academy University Charter School and/or the Rutgers Early Childhood Program?
    YesNo

    If Yes for LEAP...
    Name(s)

    Grade(s)

    Age(s)

    If Yes for Rutgers Pre-School
    Name(s)

    Age(s)

    Do you currently have any children ages 2 years or younger that are eligible to enroll in the Early Learning Research Academy Program for Infants and Toddlers?
    YesNo

    Name(s)

    Ages(s)/Grade(s)

    Name