CHILD'S INFORMATION
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Boy
Girl
Home Address
*
Street
Street Address Line 2
City, State, Zip
State / Province
Postal / Zip Code
Home Number
*
Format: (000) 000-0000.
Known Allergies Yes
*
Yes
No
Yes please list or describe
PARENT'S INFORMATION
Parent/Guardian 1
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Mobile Number
*
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
Email Address
*
Parent/Guardian 2
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Mobile Number
*
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
Email Address:
*
EMERGENCY INFORMATION
Emergency Contact
*
Name
Relationship to Child
Emergency Phone Number
*
Format: (000) 000-0000.
ENROLLMENT INFORMATION
Check Box for Class and Age
*
Princeton Poodles (0 - 1.5 Years)
Yale Yorkies (1.5 - 3 Years)
Harvard Hounds (2.5 - 4 Years)
Columbia Collies (PreK)
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
*
Please Select
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 Book a Tour
Should be Empty: