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Registration 2021-2022
Event Timing:
Current Memeber-1/18/2021
Former Member-1/25/2021
Open Enrollment-2/1/2021
Event Address: ONLINE REGISTRATION ONLY
Contact us at
phcccoop@gmail.com
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* Indicates required question
Child's Name
*
Your answer
Child's Birthdate
*
MM
/
DD
/
YYYY
Child's Gender
*
Female
Male
Other:
Guardian Name #1 and phone number
*
Your answer
Guardian #1 Occupation
*
Your answer
Guardian #1 Email
*
Your answer
Guardian Name #2 and phone number
Your answer
Guardian #2 Occupation
Your answer
Guardian # 2 Email
Your answer
Additional Email (to be included on school correspondence distribution list)
Your answer
Address (House Number, Street, City, State & Zip)
*
Your answer
Class Choice
*
3AM Monday & Wednesday 8:30-11:00 FULL (waitlist available)
3PM Tuesday & Thursday 1:30pm-4:00pm
4AM Tuesday & Thursday 8:30am-12:30pm FULL (waitlist available)
4PM Monday & Wednesday 12:00pm-4:00pm
Student Status
*
Current Member
Former Member
New Member
Is either Parent CPR certified? If so, who?
*
Your answer
Child Resides with?
*
Mother and Father
Mother
Father
Other
Brothers and Sisters- names and ages
*
Your answer
Is the child toilet trained? (Child must be toilet trained before school begins)
*
Yes
No, we are working on it.
List any special concerns about your child here:
Your answer
I understand that the $125 registration fee must be received via mail (postmarked within 2 days of acceptance) **OR** via paypal (button on main site) (within 2 days of acceptance). Non-payment may result in forfeit of registration.
*
Yes
Required
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