Registration for 2012-2013 school year

About your child

First name: Last name:

Child called: Birth date: Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 2008 2009 2010 2011

Class registering for: Infants Toddlers 2-year-olds 3-year-olds 4-year-olds Pre-K Days attending 2 3 5

Parents/guardian information

Mother:

Name:

Street address:

City: State: ZIP:

Employer: Daytime phone:

Home phone: Cell phone:

E-mail:

Father:

Name:

Street address:

City: State: ZIP:

Employer: Daytime phone:

Home phone: Cell phone:

E-mail:

Learning Lunch

Students in the 3- and 4-year-old classes have the option of staying after school to eat lunch with their friends on Wednesdays. Learning Lunch is $15 a month.

Yes, add $15 a month for Learning Lunch.

Early drop off

For an additional fee of $20 for three-day enrollment or $30 for five-day enrollment you can drop off your child as early as 8 a.m. each day of school.

Yes, I want early drop-off.

Extended stay

If you need your child to stay an extra hour at school, you can sign up for extended stay. Choose one of the following options:

1 day a week, $15 a month
2 days a week, $25 a month
3 days a week, $35 a month
4 days a week, $45 a month
5 days a week, $55 a month
No, thanks.