* Indicates Required Fields
Name of Child
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
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Age
*
Sex
Male
Female
Home Address
City
State
Home Phone
*
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Email Address
*
Name of Parent / Guardian
*
First Name
Last Name
Program Desired for Enrollment
Early Bird, 8:00am - 8:45am
Morning Session, 8:45am - 12:00pm
School Session, 8:45am - 2:30pm
Extended Day, 2:30pm - 5:00pm
VPK Full Day, 8:45am - 2:30am
VPK pm, 11:30am - 2:30pm
Days of Attendance
Mon - Fri
Mon, Wed, Fri
Tue, Thurs (pre-primary only)
Class
Pre-Primary
Primary
VPK pm
Anticipated Starting Date
/
Month
/
Day
Year
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