Registration 2021-2022
Event Timing:
Current Memeber-1/18/2021
Former Member-1/25/2021
Open Enrollment-2/1/2021
Event Address: ONLINE REGISTRATION ONLY
Contact us at phcccoop@gmail.com
Child's Name *
Child's Birthdate *
MM
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DD
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Child's Gender *
Guardian Name #1 and phone number *
Guardian #1 Occupation *
Guardian #1 Email *
Guardian Name #2 and phone number
Guardian #2 Occupation
Guardian # 2 Email
Additional Email (to be included on school correspondence distribution list)
Address (House Number, Street, City, State & Zip) *
Class Choice *
Student Status *
Is either Parent CPR certified? If so, who? *
Child Resides with? *
Brothers and Sisters- names and ages *
Is the child toilet trained? (Child must be toilet trained before school begins) *
List any special concerns about your child here:
I understand that the $125 registration fee must be received via mail (postmarked within 2 days of acceptance) **OR** via paypal (button on main site) (within 2 days of acceptance). Non-payment may result in forfeit of registration. *
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