2024-2025 REGISTRATION FORM

2024-2025 REGISTRATION FORM

4-year old
Childs Full Name
Birth Date

MonthDayYear
Sex:

BoyGirl
Address
City/State/Zip
Parent(s) names
Phone Number
Please enter a valid phone number.
Check one:

HomeMom cellDad cell
Email address
example@example.com
Please rank class selection according to preference. Fill in circle for first choice.

Mon. Fri. 8:45-11:45 am (*$280 per month)Mon.- Fri. 12:45-3:45 pm (*$280 per month)
There is a $150.00 non-refundable supplemental fee due at the time of registration and again in August Children must be four as of September 15 of upcoming school year and a resident of Iowa. *All children living in Iowa and attending 5 day classes, will attend free pending State funding. Children cannot turn 5 before September 16, 2024 to receive this benefit.

For office use only:
registration received date

MonthDayYear
Type

CashCheckOnlineOther
Should be Empty: