2026/2027 Baxter PD Day Program - Registration Request Form

2026/2027 Baxter PD Day Program - Reservation Request
PLEASE NOTE: This form is for registration in 2026 dates only, as we will be transitioning to a new registration platform in 2027. PD Day registration for 2027 dates will open in November 2026 on the new platform. Watch for emails and social media posts noting the next round of registration. Thank you for your patience!
Name of Parent/Guardian

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Number of Children to Register
Maximum of 3 children
First Child's Name

First NameLast Name
Birthdate of First Child

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Day Selection for First Child
Second Child's Name

First NameLast Name
Birthdate of Second Child

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Day Selection for Second Child
Third Child's Name

First NameLast Name
Birthdate of Third Child

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Day Selection for Third Child
Additional information about your child(ren) (i.e., does your child have any special needs that you feel we should discuss, etc.)
Do you have any questions about the PD Day Program?
Any additional comments?
Should be Empty:

2026/2027 Baxter PD Day Program - Reservation Request