Little Viking Registration form 2025-2026
Please complete this form to register your child(ren) for the Little Vikings Program

As per the State of New Jersey you must provide up-to-date immunization records for your student before your student may participate in the Little Vikings Program.
In addition, all students must provide documentation of a current flu vaccination before December 31, 2024 to continue to participate in the Little Vikings Program.
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Email *
Child's Last Name *
Child's First Name *
Child's Date of Birth *
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DD
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Child's Gender *
Parent/Guardian 1 Last Name *
Parent/Guardian 1 First Name *
Parent/Guardian 1 Address *
Parent/Guardian 1 Email Address *
Parent/Guardian 1 Cell Phone Number *
Parent/Guardian 1 Employer & Business Phone
Parent/Guardian 2 Last Name *
Parent/Guardian 2 First Name *
Parent/Guardian 2 Address *
Parent/Guardian 2 Email Address *
Parent/Guardian 2 Cell Phone Number *
Parent/Guardian 2 Employer & Business Phone
Please list the names and ages of any siblings.
Child's primary language *
Language spoken at home *
Has your child attended preschool or daycare before now? *
Is your child toilet trained? (Is able to use the restroom without assistance and wearing underwear.  Diapers and pulls ups are not permitted.) *
Does your child have any allergies?   *
What are your child's allergies?
Is your child right handed or left handed? *
What would you like us to know about your child's temperament, learning style, level of comfort with separation, etc . . .  *
What are your immediate goals for your child? *
What style/form of discipline is used at home? *
Why did you choose Little Vikings for your child? *
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