Creekside Kids Academy Application

2740 Rasmussen Road, Park City, Utah 84098
You MUST Submit before leaving this form or ALL entries will be lost.

Child

Please enter the child's full name (example: use Joseph not Joe)
Gender *
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If your application is for a child not yet born, enter baby for first name, check unborn for gender, and enter the expected delivery date in the birth date field.
Toilet trained *

Academic Year Program

Please select the academic year and academic year program you request for your child
Enrollment priority is based on submission date and time.
Visit our website creeksidekids.net for schedules, tuition, and fees
Early Learning Infant & Toddler Program: (Birth - 23 months)
Early Learning Infant & Toddler Program
Early Learning Program: (2 years to 5 years) If your child will be attending our Early Learning Program, please select your day(s), the duration and any morning or afternoon extensions.
Early Learning Program days
Early Learning Program duration
Monday Morning 
Extension
Tuesday Morning 
Extension
Wednesday Morning 
Extension
Thursday Morning 
Extension
Friday Morning 
Extension
Afternoon extension 12:00 pm
Preppy-K & Private Kindergarten Program: Our Preppy-K & Private Kindergarten Program is for older 4 year old's who have missed the cutoff date at the School District and have had 2 previous years of Preschool and 5-6 year old's.
Preppy-K & Private Kindergarten Program
Elementary After School Program
Location
Time school lets out on days your child will attend after school program
Monday
Tuesday
Wednesday
Thursday
Friday

Summer Camp Programs

Please select the summer camp year and camp program you request for your child
Enrollment priority is based on submission date and time.
Visit our website creeksidekids.net for schedules, tuition, and fees
Early Learning Infant & Toddler Program: (Birth - 23 months)
Early Learning Infant & Toddler Summer Camp
Early Learning Summer Camp: (2 years to 5 years) If your child will be attending our Early Learning Summer Camp, please select your day(s), the duration and any morning or afternoon extensions.
Early Learning Summer Camp days
Early Learning Summer Camp duration
Monday Morning 
Summer Camp 
Extension
Tuesday Morning 
Summer Camp 
Extension
Wednesday Morning 
Summer Camp 
Extension
Thursday Morning 
Summer Camp 
Extension
Friday Morning 
Summer Camp 
Extension
Afternoon Summer Camp Extension 12:00 pm
Elementary School Age Summer Camp: (5 years to 12 years) If your child will be attending our Elementary School Age Summer Camp, please select your day(s) and the duration
Elementary School Age Summer Camp days
Elementary School Age Summer Camp duration

Interest Questions

Previous care: Has your child attended any other schools or childcare before? Which? Describe their experience.
Continuing care: Do you have an interest in continuing your child’s education with Creekside Kids Academy beyond this coming year? If yes, how long?
Whom to thank: If you were referred to Creekside Kids Academy, please tell us whom to thank.
Special needs: Does your child have any special needs that we should be aware of (social, academic, physical, behavioral)?

Parent or Legal Guardian

Enter telephone number as 10 digits with no other characters

Parent or Legal Guardian Signature

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