Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Name *

First Name

Last Name

Mobile Phone *

(###)

###

####

Other Phone

(###)

###

####

What type of phone number is this?

Home

Mobile

Work

Name

First Name

Last Name

Mobile Phone

(###)

###

####

Other Phone

(###)

###

####

What type of phone number is this?

Home

Mobile

Work

Are you a returning or alumni family? *

Yes

No

Desired Start Date *

MM

DD

YYYY

What are your preferred enrollment days (8:30am-12:30pm)? Please check all that apply). *

Monday

Tuesday

Wednesday

Thursday

Friday

What are your preferred enrollment days for the extended day program (12:30pm-3:30pm)?

Monday

Tuesday

Wednesday

Thursday

Friday

I understand that if my child is accepted, 30 days written notice is required prior to withdrawal from the school. *

I accept these terms

Do you grant permission for photos/videos of your child, while in scheduled preschool activities, to be used by the school for publicity or educational purposes? *

Yes

No