2021-2022 Preschool Registration
Thank you for your interest in our program! Please complete this form, and we will be in touch with you shortly!
Email *
Child's name (First and Last) *
Child's Nickname
Child's Gender *
Child's birthday *
Which program do you want to enroll your child in? *
Has the child attended daycare or preschool before? *
If yes, where?
Is your child potty trained/able to use the bathroom independently? (Without pull-ups) *
Guardian Name (First and Last) *
Relationship to child *
Address (include city and zip code) *
Primary phone number *
Primary phone type *
Employer & Job title (if applicable)
Employer phone number
Additional guardian name (First and Last)
What is your relationship to the child? *
Additional guardian phone number
Additional guardian email
Employer & Job title (if applicable)
Employer phone number
What is your child's t-shirt size? *
How did you hear about our program? If you were referred by a member of our community, please leave their first and last name here.
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