Class Interest *

PreK4

Transitional Kindergarten

Lunch Bunch [optional extra 30 minutes/day] + $50/monthly

Name of Child *

First Name

Last Name

Child Birthday *

MM

DD

YYYY

Child's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Primary Parent/Guardian Child Resides With *

First Name

Last Name

Phone Number *

(###)

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Name of Secondary Parent/Guardian Child Resides With *

First Name

Last Name

Phone

(###)

###

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Alternative Emergency Contact #1 *

First Name

Last Name

Phone

(###)

###

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Alternative Emergency Contact #2 *

First Name

Last Name

Phone

(###)

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