STUDENT ENROLLMENT FORM

Register your child

Fill out this form to begin the registration process. We will contact you with openings and the next steps. If you don’t receive an email in 2 business days, please check your SPAM folder.

Child's Name

First Name

Last Name

Date of birth

Sex

Is your child potty trained?

Has your child had prior preschool experience?

If yes, where, when and for how long?

Classes begin at 18 months old. Please check the days you would like to attend:

2 days (T/Th)

3 days (M/W/F)

5 days (M-F)

Add Extended Care Options:

No Extended Care (9:00-2:00)

Add extended care AM (7:30-9:00)

Add extended care PM (2:00-3:30)

AM & PM extended care (7:30-3:30)

Additional Information

Address

Does your child live with both parents?

Mother's Name

First Name

Last Name

Mother's Email

Mother's Phone

(###)

###

####

Father's Name

First Name

Last Name

Father's Email

Father's Phone

(###)

###

####

Any additional information?