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Pisgah Child Development Waiting List
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* Indicates required question
Email
*
Your email
Child's First & Last Name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Today's Date
*
MM
/
DD
/
YYYY
What type of enrollment are you looking for?
*
Preschool Half-Day (7:30AM - 12:00PM)
Preschool Full-Time (7:30AM - 6:00PM)
Afterschool Full-Time (2:30PM - 6:00PM Monday-Friday)
Afterschool Drop-In (2:30PM - 6:00PM As Needed)
Summer Program Part-Time (7:30AM - 6:00PM Up to 3 days a week)
Summer Program Full-time (7:30AM - 6:00PM 5 days a week)
Required
If afterschool, what school does your child attend?
Pleasant Hill Elementary
Pleasant Hill Middle
Rocky Creek Elementary
Lake Murray Elementary
Deerfield Elementary
Centerville Elementary
Gilbert Elementary
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Parent/Guardian First & Last Name
*
Your answer
Contact Info: Email & Phone Number
*
Your answer
Address: Street - City - State - Zip Code
*
Your answer
Are you a Pisgah Lutheran Church Member?
*
Yes
No
Do you currently have a child enrolled in our program?
*
Yes
No
Notes:
Your answer
Send me a copy of my responses.
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