Please complete the following information. We will get in touch with you shortly. Thanks!
Today's Date *
Child's Full Name *
Name Called *
Age as of September 1, 2014 *
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) *
(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.
Enter the following for security *