Enrollment Application

Apply to Footsteps

We're so glad you're here. Complete the application below and pay the one-time $110 application fee to confirm your child's spot on our waitlist.

Takes about 5 minutes · Your progress saves automatically · Sections marked “optional” are safe to skip.

Child's Information

First Name *

Middle Name

Last Name *

Sex

Birthday *

Location *

Address

City

State

Zip Code

Desired Start Date

Which schedule are you looking for? *

Estimated Drop-off Time

Estimated Pick-up Time

Any known medical conditions / chronic illness? (e.g. asthma, allergies, history of illness)

Special Dietary Needs

Parent / Guardian #1

Full Name *

Relationship

Address (if different from above)

Cell Phone *

Home / Work Phone

Email *

Preferred Method of Contact

How did you hear about us?

Parent / Guardian #2 (optional)

Full Name

Relationship

Address (if different from above)

Cell Phone

Home / Work Phone

A Few More Questions Optional

Do you have a Footsteps affiliation already?

Health Concerns or Special Needs

Child's Siblings

Current or Previous Services (OT, Speech, etc.)

How do you think you'll handle separation?

What are you thinking for after Footsteps?

Just for Fun 🙂 Optional

A few playful questions to get to know your family's style — totally optional.

Your child colors all over the walls right before guests arrive. You're more likely to:

Rate Your Crazy

You finally sit down with a hot coffee and your child immediately needs something. You:

It's picture day and your child refuses to wear the outfit you chose. You're more likely to:

Agreement & Signature

One-time, nonrefundable application fee $110

Parent / Guardian Signature — type your full legal name *

Date *

You'll be taken to our secure Stripe checkout to pay the $110 fee. Your card details never touch our site.