Hudson Valley Sudbury School

PO Box 159

West Hurley, NY 12491

845-679-1002

Enrollment Interview Request

Please return this form, fully completed, to the Enrollment Clerk, Hudson Valley Sudbury School, PO Box 159, West Hurley, NY 12491. The Enrollment Clerk will contact you to arrange an interview.

For each child interviewing:

Name: _____________________________________ Date of Birth: _____________________

Name: _____________________________________ Date of Birth: _____________________

Name: _____________________________________ Date of Birth: _____________________

Name: _____________________________________ Date of Birth: _____________________

Name(s) of adults accompanying the interviewee: (As a matter of policy, we require all parents or guardians with legal custody to attend the interview.)

Name: ___________________________________________

Address: _____________________________________________________________________

Home Telephone: ________________

Name: ___________________________________________

Address (if different): __________________________________________________________

Home Telephone (if different): ________________

Daytime Telephone: _____________________ Whose number is it? ____________________

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

For office use only

Date and time of interview: _________________________________________________________________

Interviewed by: _________________________________________________________