Lighthouse Preschool Waiting List
Your Child's Name
Your Child's Birthdate
-
Month
-
Day
Year
Date
Is Your Child Potty Trained?
Yes
No
Is Your Child Male or Female?
Male
Female
Child's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father's Name
Mother's Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Program
5 Days (Mon-Fri)
3 Days (Mon, Wed, & Fri)
2 Days (Tues & Thurs)
Half Day vs. Full Day
Half Day
Full Day
Comments
Type a question
Submit
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