Enrollment Application

Child's Name *

First Name

Last Name

Child's DOB *

MM

DD

YYYY

Is your child fully toilet-trained? *

Yes

No

Parent/Guardian's Name *

First Name

Last Name

Phone *

(###)

###

####

Requested attendance schedule: *

Five Days (Monday through Friday 8:00-4:30)

Three Days (Monday/Wednesday/Friday 8:00-4:30)

Two Days (Tuesday/Thursday 8:00-4:30)

Preschool Half Day For Ages 3-5 Only (Monday through Friday 8:00-12:30)

Please select the program(s) you are applying for: *

2025 Summer Program

2025-2026 School Year

Preferred date of enrollment *

MM

DD

YYYY