Registration 2024-2025
August 2024-May 2025
Student Name
*
Age by Aug. 1, 2024
*
Date of Birth
*
Address
*
City
*
State
*
Zip Code
*
Elementary School They Will Be Attending
*
Email Address
*
Mother’s Name
*
Phone Number
*
Occupation/Employer
*
'
Phone Number
*
Father’s Name
*
Phone Number
*
Occupation/Employer
*
Phone Number
*
Student’s Siblings (Name and Ages)
*
Allergies
*
Does your child have any speech, hearing, or other physical issues of which we should know?
*
If yes, please explain
Class Selection
*
Please Select
AM Class Mon-Wed 9-11:30am ($135/mo)
PM Class Mon-Wed 1-3:30pm ($135/mo)
2's Playgroup Th-Fri 9-11am ($110/mo)
If Class Selection is unavailable I would like to:
*
Be on the wait list for class selected AND enrolled in age appropriate class
Be on the waitlist for selected class ONLY
Enroll in an age appropriate class that has openings
Talk to a Staff Member about Options
If age appropriate classes are full, add me to the waitlist for first available.
Submit
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