2019-2020 Preschool Registration

Child's Name	*
Nickname
Child's Date of Birth	*
Parent/Guardian Name	*
Street Address	*
City	*
State	*
Zip	*
Home Phone Number
Cell Phone Number
Email Address (will be used for classroom communication)
What is the best way to contact you?	*  Home PhoneCell PhoneEmail Address
How did you hear about our Preschool? *
Did a parent or teacher refer you? Name of person that referred you?
Do you know someone that would like more information about our Preschool Academy or do you have a friend you would refer to our Preschool Academy? *
Please Select Desired Class (child must be of age by Sept 1st) No Exceptions!	*  Mother's Morning Out (3-12 mo.) 1 day per weekMother's Morning Out (3-12 mo.) 2 days per weekOne Year Old Class ( 2 days)Two Year Old Class (2 days)Two Year Old Class (3 days)Two Year Old Class (5 days)Three Year Old Class (3 days)Three Year Old Class (5 days)Four Year Old Class (5 days)Kindergarten Class (5 days)
Your Email Address	*