Child's Name *

First Name

Last Name

Date of Birth (Click on year to change year)

A child must be 5 by Sept 30 to enroll in Kindergarten. We are able to make exceptions on a case-by-case basis (submit this form & we will contact you with further information regarding exception policy).

MM

DD

YYYY

Program Schedule (Visit Our Tuition Rates Page on Our Website For Rates) *

7 am to 6 pm (Extended Schedule)

8 am to 4:30 pm (Semi-extended Schedule)

8 am to 3:30 pm (Regular Schedule)

Name of Person Completing This Form

YOUR NAME

First Name

Last Name