Challenge School Preschool Registration
Child's Name (FirstName LastName)
*
FirstName LastName
Child's Date of Birth
*
/
Month
/
Day
Year
Date
Child's Sex
*
Male
Female
Mother/Guardian Name
*
FirstName LastNAme
Mother's/Guardian's Cell Phone
*
-
xxx
xxx-xxxx
Mother's/Guardian's Email
*
example@example.com
Father/Guardian Name
FirstName LastNAme
Father's/Guardian's Cell Phone
-
xxx
xxx-xxxx
Father's/Guardian's Email
example@example.com
Child's Home Address
*
Schedule and Campus Preferred
*
San Mateo Campus
Belmont Campus
Fremont Campus
Foster City Campus
When do you want your child to start?
/
Month
/
Day
Year
Date
What's your child's first language at home?
*
Important medical limitations and special conditions
*
allergies to medicine or food, Asthma etc
Does your child have any previous childcare experience
*
How did you hear about Challenge School
Referral
Web Search
Yelp
Open House
Other
If referral, please name the provider
Math Captcha
My Products
*
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Non-refundable Challenge School Registration Fee
$
100.00
Total
$
0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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