New Student Preschool Registration

Student Information

* Name of Child

* Birthday:

* Gender:

* For which class are you enrolling?

Schedule Desired

5 day

3 day

3 dayMonday, Wednesday, and Friday

School Hours

Are you enrolling a second child??

Student 2 Information

* Name of Child

* Birthday:

* Gender:

Schedule Desired

For which class are you enrolling?

5 day

3 day

3 dayMonday, Wednesday, and Friday

School Hours

Parent / Guardian 1

* First Name:

* Last Name:

* Primary Address:

* City:

* State:

* Zip Code:

* Phone 1 (Mobile):

* Phone 2 (Home):

* Email:

Is there a second parent/guardian?

Parent / Guardian 2

Name:

Does this parent/guardian live at a different address?

Primary Address:

City:

State:

Zip Code:

Phone 1:

Phone 2:

Email:

* By submitting this form, you agree to pay the $875 non-refundable application ($75) and administrative fees ($800)

By submitting this form, you agree to pay the $875 non-refundable application ($75) and administrative fees ($800)

Total Due Today

Your application fee and Administrative fees must be paid upon submission.

Fri, May 20 2022 19 Iyyar 5782