AGAPE Registration 2018-19
Please complete all required fields below. Your application will be complete when this form is submitted and AGAPE has received your application fee of $50/new student or $40/returning student.

All students must be the required age for the class by September 30, 2018 with the exception of the 5-day fours. 5-day students must be 5-years-old by April 30, 2019.

Classes meet on the following weekdays:

Twos: Monday & Wednesday
Threes: Monday, Wednesday & Friday
Fours: Monday, Wednesday & Friday or Monday, Tuesday, Wednesday & Friday or all 5 days
ESL: Monday, Wednesday & Friday

My child is a *
Child's First Name *
Your answer
Child's Middle Name
Your answer
Child's Last Name *
Your answer
All email addresses to which you want communication to be sent *
Your answer
First Choice Class *
Second Choice Class (if first choice is unavailable) *
Sex *
Date of Birth *
MM
/
DD
/
YYYY
Home Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Phone
Your answer
Mother's First Name *
Your answer
Mother's Last Name *
Your answer
Mother's Employer
Your answer
Mother's Cell Phone *
Your answer
Mother's Work Phone
Your answer
Father's First Name *
Your answer
Father's Last Name *
Your answer
Father's Employer
Your answer
Father's Cell Phone *
Your answer
Father's Work Phone
Your answer
Allergies (food, seasonal and environmental)
Your answer
Special Needs
Your answer
I understand that AGAPE is predominantly a cooperative preschool. If I enroll my child in a co-op class, I understand that I must co-op approximately once a month to receive the $35 credit. (Type your full name to indicate agreement.) *
Your answer
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