Preschool Summer Program Registration
Held at the Southside Campus only. A minimum of 10 students must be enrolled for a session to be offered.
Email address *
Your answer
Student's First Name *
Your answer
Student's Last Name *
Your answer
Date of Birth *
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DD
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Gender *
Social Security Number
Your answer
Student's Street Address *
Your answer
Student's Zip Code *
Your answer
Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Parent's Street Address *
If different than student's
Your answer
Parent's Zip Code *
If different than student's
Your answer
Parent's Home Phone *
Your answer
Parent's Cell Phone *
Your answer
Current School
Your answer
Special Needs
Your answer
Check the weeks you wish your child to attend *
A minimum of 10 students must be enrolled for a session to be offered.
Required
Select the number of days per week you would like your child to attend. *
Select the hours of class you would like your child to attend and if you would like bus service. *
Bus service is limited in area. A minimum of 6 bus riders must be enrolled for bus service to be available.
How did you find out about our program? *
Completed by *
Type your full name
Your answer
Your relationship to the student *
Your answer
Date form completed. *
MM
/
DD
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YYYY
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