Preschool Enrollment Form

Please fill in the information below and submit your Enrollment Application. Any field with an asterisk * is required.

Child's Full Name Child's Full Name First Last
Birth Date Birth Date / MM / DD YYYY
Home Address Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone: Home Phone: - ### - ### ####
Mobile Phone: Mobile Phone: - ### - ### ####
Your Email
Check the class you wish to enroll your child (check only one).

Check the class you wish to enroll your child (check only one). 3 Year Olds - Two days per week (Tue/Thurs from 9:00 am - 11:30 am) Price $157 month 4 Year Olds - Three days per week (M/W/Th from 9:00 am - 11:30 am) Price $186 month 4-day 4s (Pre-K) - Four days per week (M/T/W/Th from 9:00 am - 11:30 am) Price $213 month
Parent's / Legal Guardian Signature - Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.