PROGRAM REGISTRATION FORM
Parent Information
Parents/Guardian (1)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian (2)
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Please input address if different from parent/guardian (1).
CHOOSE
YOUR PROGRAM...
I would like to enroll
*
Child 1- First Name
Last Name
Into the following From "U" University Program
*
Please Select
2 Day- Early Learning Enrichment
3 Day- Early Learning Enrichment
3 Day- Kindergarten Readiness
5 Day- Kindergarten Readiness
Does this child have any previous formal education?
*
Please Select
Yes, school.
Yes, educational childcare.
No.
Not sure.
I would also like to enroll
Child 2- First Name
Last Name
Into the following From "U" University Program
Please Select
2 Day- Early Learning Enrichment
3 Day- Early Learning Enrichment
3 Day- Kindergarten Readiness
5 Day- Kindergarten Readiness
Does this child have any previous formal education?
Please Select
Yes, school.
Yes, educational childcare.
No.
Not sure.
Anticipated Start Date (Child-1)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Anticipated Start Date (Child-2)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Comments
Please Check to Acknowledge
*
I understand the completion of this registration form does not guarantee my child(ren)'s acceptance into the program; and that additional forms, agreements, assessment, observation, and payment need to be completed prior to my child(ren) being accepted and subsequently completely enrolled and space held.
Register
Should be Empty: