Child First Name
*
Child Last Name
*
Home Phone Number
*
Age (As of Enrollment)
*
Date of Birth
*
Sex
*
M
F
Address
*
City
*
Mothers Name
*
Work Phone Number
*
Email Address
*
Desired Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Desired Time - Preschool
8:45 - 12:15
12:45 - 4:15
7:30 - 5:00
Desired Time - Pre-K
8:45 - 12:30
12:45 - 4:30
7:30 - 5:00
Desired Time - Kindergarten
8:45 - 12:30
12:45 - 4:30
7:30 - 5:00