Registration Form
Please fill out the information below to register your child. Up to three children may be registered using this form. Registration is not complete until this form has been submitted along with the $100 non-refundable registration fee (per family).
Parent/Caregiver Information
Please enter the information for the primary adult contact.
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Relationship to Child
*
Please Select
Mother
Father
Primary Caregiver
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
*
Please Select
Newspaper
Internet
Magazine
Other
Please Specify
Add Additional Parent/Caregiver
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
example@example.com
Relationship to Child
Please Select
Parent: Mother
Parent: Father
Parent: Other
Primary Caregiver
Address (leave blank if same as above)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Information
Child's Information
Children must be at least 3 years old (and potty trained) by September 1. You may register up to three children per form.
Full Name
*
First Name
Last Name
Preferred Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Other/Prefer not to say
Please Select Preferred Dates of Attendance (minimum of 2)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Register Second Child
Full Name
First Name
Last Name
Preferred Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Female
Male
Other/Prefer not to say
Please Select Preferred Dates of Attendance (minimum of 2)
Monday
Tuesday
Wednesday
Thursday
Friday
Register Third Child
Full Name
First Name
Last Name
Preferred Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Female
Male
Other/Prefer not to say
Please Select Preferred Dates of Attendance (minimum of 2)
Monday
Tuesday
Wednesday
Thursday
Friday
After submitting this form, please follow the instructions on the LEAD page to remit the registration fee of $100 per family (this is a one-time, non-refundable fee). Registration is not complete until both the form and the fee have been received. When both have been submitted, we will confirm your completed registration via email.
Submit
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