Please complete the following information. We will get in touch with you shortly. Thanks!
Child's Full Name*
Age as of September 1, 2014*
Name of Parent/Guardian with whom child lives*
Home Phone (xxx-xxx-xxxx)
Cell Phone (xxx-xxx-xxxx)*
Work Phone (xxx-xxx-xxxx)*
(Optional) Add Early & After Care:
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.
Early & After Care: Early Care 7:30 a.m.-9:00 a.m.