CHILD'S INFORMATION
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Boy
Girl
Address
Street Address
Apt#
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home Number
*
-
Area Code
Phone Number
Known Allergies
*
Yes
No
Yes please list or describe
PARENT'S INFORMATION
Parent/Guardian 1
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Best Contact Number
*
-
Area Code
Phone Number
Work Number
-
Area Code
Phone Number
Email Address
*
Parent/Guardian 2
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Mobile Number
*
-
Area Code
Phone Number
Work Number
-
Area Code
Phone Number
Email Address:
*
EMERGENCY INFORMATION
Emergency Contact
*
Name
Relationship to Child
Emergency Phone Number
*
-
Area Code
Phone Number
ENROLLMENT INFORMATION
Check Box for Class and Age
*
Princeton Poodles (0 - 1.5 Years)
Columbia Collies (1 - 2.5 Years)
Yale Yorkies (1.5 - 3 Years)
Harvard Hounds (2 - 3.5 Years)
Check Box for Full or Part Time
*
Full Time (Mon-Fri, 8am to 6pm)
Part Time (M, W, F, 8am to 6pm)
Select Period of Enrollment
*
January to December
February to January
March to February
April to March
May to April
June to May
July to June
August to July
September to August
October to September
November to October
December to November
Desired Start Date
*
-
Month
-
Day
Year
Submit Application and Schedule a Tour
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