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Today's Date *
Child's Full Name *
Name Called *
Age as of September 1, 2014 *
Birthdate (mm/dd/yyyy) *
Name of Parent/Guardian with whom child lives *
Mailing Address *
Zip Code *
Home Phone (xxx-xxx-xxxx)
Cell Phone (xxx-xxx-xxxx) *
Work Phone (xxx-xxx-xxxx) *
Choose Age Group *
Infant (must be 8 weeks and have immunizations)
Creepers (6 months - 12 months)
Two Year Olds
Three Year Olds (must be potty trained by Sept 1)
Four Year Olds
(Optional) Add Early & After Care:
Early & After Care: Early Care 7:30 a.m.-9:00 a.m.
After Care 2:00 p.m.-5:30 p.m.
Both Early and After Care 7:30 a.m.-9:00 a.m. and 2:00 p.m.-5:30 p.m.
ADDITIONAL FEES APPLY
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