ENROLLMENT APPLICATION      Online Registration Fee Just $30    (print, scan then send it back thru email)    

 

Make CC Payments via Donation tab

Make checks payable to Rubies and mail in to:

6100 N 42nd Street lower

Milwaukee, WI 53209 

 

Applicant Information

Applicant’s Name: ________________________________________   Age: _____________

Home Address: __________________Phone: _____________________

City _____________________________________________ State ______________________

Zip Code ________________________ Food Allergies? ____Yes ____ No

If yes, please list: __________________________________________________________________________________________________________________________________________________________________________

Transportation Needed? ___ Yes or ___No  (within a 15 mile radius of the center)

 If yes, P/U Time & Address: _________; _________________________________________

 

Parent/ Guardian Information

 

Parent/Guardian Name:  ______________________________________________

Address:___________________________________________________City:__________State: ______ Zip: _______________Home Phone : _________________________

Work Phone ________________________Email address ____________________________

 

Annual Household Income: _____ $0-$20,000 _____$20,000-$30,000 _____$30,000-$40,000 _____$40,000-$50,000 _____$50,000-$60,000 _____ $60,000-$70,000 _____$70,000-$80,000 _____$80,000-$90,000 _____ above $100,000

 

Emergency Contacts

 

Contact Name: ________________________________________________

 

Relationship to child: __________________________________________________________________

 

Home Phone: ______________________________ Cell Phone: _____________________

 

Contact Name: ________________________________________________

 

Relationship to child: __________________________________________________________________

 

Home Phone: ______________________________ Cell Phone: _____________________

 

Payment Method

Money Order ___  Check ___ CC ___

 

Signatures

Applicant Signature: ___________________________________________ Date: ________________

Parent Signature: _____________________________________________ Date: _________________

 

 


We are always looking for parents volunteers, if you are interested please call us at 414-214-7289