Child's First Name:         Last Name:   

Birthdate (mm/dd/yyyy):   

Parent's Name:   

Mailing Address:   

City:           State:        Zip Code:   

Telephone Number with area code: ()   -

Classes offered:

PreKindergarten, 4 & 5 year olds
   2 Days/week
   3 Days/week

Preschool, Fall Birthday (Sept-March), 3 year olds
  1 day/week
  2 days/week

Preschool, Spring & Summer Birthday (April-August), 2-1/2 & 3 year olds
  1 day/week