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2021-2022 Preschool Registration Application
Thank you for your interest in our program! Please complete this form, and we will be in touch with you shortly!
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* Indicates required question
Email
*
Your answer
Child's name (First and Last)
*
Your answer
Child's Nickname
Your answer
Child's Gender
*
Female
Male
Child's birthday
*
MM
/
DD
/
YYYY
Which program do you wish to enroll your child in?
*
Full Day (Monday - Friday) 7am - 5pm - $740
Half Day (Mon-Friday) 8:30am-11:30am - $300 *My child will be four years old by August 1st.
Virtual Preschool - $150
Required
Has the child attended daycare or preschool before?
*
Yes
No
If yes, where?
Your answer
Is your child potty trained/able to use the bathroom independently? (Without pull-ups)
*
Yes
No
Guardian Name (First and Last)
*
Your answer
Relationship to child
*
Your answer
Address (include city and zip code)
*
Your answer
Primary phone number
*
Your answer
Primary phone type
*
Home
Cell phone
Work
Employer & Job title (if applicable)
Your answer
Employer phone number
Your answer
Additional guardian name (First and Last)
Your answer
What is your relationship to the child?
*
Your answer
Additional guardian phone number
Your answer
Additional guardian email
Your answer
Employer & Job title (if applicable)
Your answer
Employer phone number
Your answer
What is your child's t-shirt size?
*
YXS
YS
YM
YL
YXL
How did you hear about our program? If you were referred by a member of our community, please leave their first and last name here.
Your answer
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