If you are interested in enrolling at Shepherd's Way Day School please fill in the form below.  A staff member will contact you concerning availability of space.  If we all spaces are occupied, you will be added to our waiting list.

Name:    
Email Address:            
Confirm Email Address:

Phone Number: HOME (ex. 999-999-9999)
Phone Number: WORK(ex. 999-999-9999)
Phone Number: CELL   (ex. 999-999-9999)

Child's Name:
       and DOB: MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Child's Name:
       and DOB: MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Please indicate the type of care you need:
     Part Time: Tuesday/Thursday
     Part Time: Monday/Wednesday/Friday
     Full Time
     School-Age (Before/After School)
     Summer Camp

**Once enrolled in any of our part-time programs, these parents have first priority for full-time care (if full-time is needed).

When do you need care?

Questions or Comments:

 

**Please call bi-monthly to update your information.

SPACE is based on AVAILABILITY

 

If you prefer to mail your information, please print the form (this is a PDF file and requires Acrobat Reader download here for free),
fill it in completely and mail or fax to:

Shepherd's Way Day School
1575 John Knox Drive
Colfax, NC  27235

or

fax to 336-665-5008

If you have questions, please email:   swdsriverlanding@hotmail.com