2024/2025 Enrichment Registration Form

Enrichment Registration Form

2024/2025
Child Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age as of 12/1/24*
Sex*

MaleFemale
Potty Trained?*

YesNo
Desired Start Date

MonthDayYear
Date
Parent Name*

First NameLast Name
I understand that children that are not potty trained and/or under the age of 2 years will need an adult to remain with them?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Ok to Text?*

YesNo
Registration fee plus first payment must accompany this form. The registration fee is non-refundable for any reason. Payments can be made by check and dropped off to Little Clover Learning Center Monday-Friday 8:45am-1:00pm. Little Clover Learning Center reserves the right to cancel any class due to lack of enrollment.
I, First Name* Last Name* ,understand and abide by this statement.
Signature*

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PAYMENT

use discount code "check2024" if a check was sent for payment

Registration Payment*

New Registration for Enrichment

$50.00 Quantity

Little Clover Tee Shirt

$10.00

Little Clover Mug

$10.00

Little Clover Wet Bag

$10.00 Quantity

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

Apple Pay

Google Pay

Cash App Pay

Enrichment Registration Form