Adult First and Last Name (Only registered adults may attend the program) *
Your answer
Child First and Last Name (If you have more than one child you would like to register, please register them together. Only registered children may attend the program) *
Your answer
Child Date of Birth (If you have more than one child you would like to register, write both of their dates of birth) *
Your answer
Phone Number *
Your answer
Are you currently registered in any other programs that LAMP EarlyON offers? Please note that priority will be given to families not currently registered in any other programs. *
Please write the name of the LAMP EarlyON programs your child attends.
Your answer
Please share any information that will improve your child's experience in the program (e.g. interests or dislikes)