Lone Mountain Children's Center
Application Form
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Please indicate the class for which you are applying (the ages are the September age):
*
TUESDAY-THURSDAY PROGRAM (9:00am-1:00pm) 2yrs & 7mos to 3yrs & 5mos
MONDAY-WEDNESDAY-FRIDAY PROGRAM (9:00am- 1:30pm) 3yrs & 6mos to 4yrs & 4mos
PRE-KINDERGARTEN PROGRAM (8:30am- 2:00pm) 4yrs & 5mos to 5yrs & 4mos
Select the school year for which you are applying:
*
Please Select
2026-2027 School Year
2027-2028 School Year
2028-2029 School Year
2029-2030 School Year
Parent/Guardian's Information
Parent/Guardian's Name - Primary
*
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's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment:
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next
( X )
Application Fee
$
75.00
Payment Methods
Choose from one of the PayPal options to
make your payment.
Submit
Should be Empty: