"*" indicates required fieldsStep 1 of 425%Today's Date MM slash DD slash YYYY Child's Name* First Last Child's Birth Date* MM slash DD slash YYYY Child's age on Sept 1, 2022*Include Years AND MonthsGender Male FemaleContact Information:Father/Guardian Name First Last Father/Guardian Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Father/Guardian Email Father/Guardian Work Phone NumberFather/Guardian Cell Phone NumberFather/Guardian Cell NetworkMother/Guardian Name First Last Mother/Guardian Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother/Guardian Email Mother/Guardian Work Phone NumberMother/Guardian Cell Phone NumberMother/Guardian Cell NetworkMorning Class (8:45 - 11:45 am)Age Group* 18 Months Twos Threes Fours YTG Kindergarten18 months/2 Years please select* Stay and Play NIbble and NapPlease number your preference from 1-3.Tuesday/Thursday 1 2 3Monday/Wednesday/Friday 1 2 3Monday through Thursday (3s and 4s Only) 1 2 3Monday through Friday 1 2 3Notes to Director for Placement ConsiderationTeacher request is not a guarantee of class placement.Afternoon Class (11:45 am - 2:30 pm)Total number of afternoons requestedSelect the days of the week Monday Tuesday Wednesday Thursday Friday Fall Afternoons: (Subject to Change) Spring Afternoons: (Subject to Change) Non-Refundable Fee Agreement* I understand my non-refundable Registration Fee of $200 is due upon registration.I plan to pay using Check Cash Credit Card/Bank Draft (3% processing fee added for credit card, $1 for bank draft)Signature*NameThis field is for validation purposes and should be left unchanged. Fall Afternoons: (Subject to Change) Spring Afternoons: (Subject to Change)
