Registration Form | Little Hearts Christ

Program Registration

Please fill out this form to register for our program.

First name

Last name

Email address

Phone number

Address

I would like my child to attend:

Half Day Preschool (8AM - 12PM)

Full Day Preschool (8AM - 4PM)

After School Program (3:30PM - 6PM)

Child's Birthday

Month

Day

Year

Childs's Gender

Boy

Girl

Has your child attended preschool before?

Yes

No

If yes, which preschool did they attend?

Is your child potty trained?

Yes

No

Emergency Contact & Authorized Person to pick your child up. Name/Address/Phone #

Please Upload Required Enrollment Forms

Signature

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