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Registration Form
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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 #
Emergency Contact & Authorized Person to pick your child up. Name/Address/Phone #
Emergency Contact & Authorized Person to pick your child up. Name/Address/Phone #
Please Upload Required Enrollment Forms
Birth Certificate, Shot Record, Physical
Signature
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Non-Refundable Deposit This will be credited to your child's tuition the first week of school.
$50
Register Now
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