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Preschool Readiness Group
2020 Year
Contact us at 847-707-6744 or
Kaley@littlestepspt.com
if you have any questions
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* Indicates required question
Child's Name
*
Your answer
DOB
*
MM
/
DD
/
YYYY
Parent's name
*
Your answer
Email:
*
Your answer
Best Contact Number
*
Your answer
Which Location are you Signing up For?
*
Glenview (Fridays 9:00am-11:00am)
Highland Park (Fridays 9:00am -10:30am )
Wilmette (Wednesdays 9:00am-10:30am)
Required
Which Session(s) are you signing up for?
*
Sesson 1
Session 2
Session 3
Session 4
Required
How would you like to pay?
*
Credit Card - Please call me to get number
Credit Card- Please bill the card on file
Check (Please bring to first day of group)
Required
Does your child have any allergies or health issues we should be aware of.
*
Your answer
Dietary restrictions
*
None
Vegetarian
Vegan
Kosher
Gluten-free
Other:
I understand that my account will be assessed the full program fee by the first day of the program.
*
Yes
Required
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