Parent's Day Out (PDO) Application

Please fill out the form below in its entirety. Upon submission, it will be electronically delivered to Priscella Celentano, our Director of Admissions. If, after submission, you would like to change any information on the form, please contact her via email.

Student Information

Applying Student Name (Last, First)*

Email*

Today’s Date*

Entering Fall of Year*

Student Last Name*

Student First Name*

Student Middle Name

Prefers to Be Called

Date of Birth*

Gender*

Home Address Line 1*

Home Address Line 2

City*

State*

ZIP Code*

Primary Phone Number*

Family Information

Parent/Guardian 1 Title

Parent/Guardian 1 Last Name*

Parent/Guardian1 First Name*

Parent/Guardian 1 Relation to Child*

Parent/Guardian 1 Address (if different)

Parent/Guardian 1 Email*

Email Parent/Guardian 1

Parent/Guardian 1 Cell Phone Number*

Call Parent/Guardian 1

Parent/Guardian 1 Occupation

Parent/Guardian 1 Employer

Parent/Guardian 2 Title

Parent/Guardian 2 Last Name

Parent/Guardian 2 First Name

Parent/Guardian 2 Relation to Child

Parent/Guardian 2 Address (if different)

Parent/Guardian 2 Email Address

Email Parent/Guardian 2

Parent/Guardian 2 Cell Phone Number

Call Parent/Guardian 2

Parent/Guardian 2 Occupation

Parent/Guardian 2 Employer

Sibling 1 Name (Last, First)

Sibling 1 Gender

Sibling 1 Birth Date

Sibling 1 Current School

Sibling 1 Current Grade

Sibling 2 Name (Last, First)

Sibling 2 Gender

Sibling 2 Birth Date

Sibling 2 Current School

Sibling 2 Current Grade

Sibling 3 Name (Last, First)

Sibling 3 Gender

Sibling 3 Birth Date

Sibling 3 Current School

Sibling 3 Current Grade

Sibling 4 Name (Last, First)

Sibling 4 Gender

Sibling 4 Birth Date

Sibling 4 Current School

Sibling 4 Current Grade

How did you hear about Seneca Academy?*

Please list any current or past Seneca Academy families you know.

Student Background

The following questions help us learn about your child. Please answer them to the best of your ability. Thank you.

Does your child separate easily from you?*

Does your child have any special fears?*

What are some of your child’s favorite activities?*

Is there anything else you would like us to know?*

Class Selection

Please note that students must turn 2 by September 1, 2021 to enroll in Parent’s Day Out classes.

First Choice*

Second Choice*

Enter the Captcha

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By clicking “submit” below, I affirm that I have included all the relevant and necessary information that may affect this student’s educational performance and progress. I understand that this information is to be reviewed only by the Admissions Committee to evaluate Seneca Academy’s ability to appropriately meet the educational needs of this student. Further, I understand and accept that falsification, deception, or omission in any aspect of the application process may result in an immediate review and possible revocation of admissions.