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Parent First Name
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Phone
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Alternate Phone :
Email
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Alternate Email :
Number of Children:
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Please Select Number of Children
1
2
3
Child First Name
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Child Last Name
*
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Child Date of Birth
*
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Desired start Date
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Preferred Program
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Select Program
Full Day M-F (8:00 AM - 6:00 PM)
Full Day MWF (8:00 AM - 6:00 PM)
Full Day TTH (8:00 AM - 6:00 PM)
Half Day M-F (8:30 AM - 11:30 AM)
Half Day MWF (8:30 AM - 11:30 AM)
Half Day TTH (8:30 AM - 11:30 AM)
Extended Day M-F (8:30 AM - 2:30 AM)
Extended Day MWF (8:30 AM - 2:30 AM)
Extended Day TTH (8:30 AM - 2:30 AM)
After School Program (11:30 AM - 6:00 PM)
After School Program (2:30 PM - 6:00 PM)
Undecided
Potty Trained
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Yes
No
Child 2 First Name
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Child 2 Last Name
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Child 2 Date of Birth
*
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Child 2 Desired start Date
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Child 2 Preferred Program
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Select Program
Full Day M-F (8:00 AM - 6:00 PM)
Full Day MWF (8:00 AM - 6:00 PM)
Full Day TTH (8:00 AM - 6:00 PM)
Half Day M-F (8:30 AM - 11:30 AM)
Half Day MWF (8:30 AM - 11:30 AM)
Half Day TTH (8:30 AM - 11:30 AM)
Extended Day M-F (8:30 AM - 2:30 AM)
Extended Day MWF (8:30 AM - 2:30 AM)
Extended Day TTH (8:30 AM - 2:30 AM)
After School Program (11:30 AM - 6:00 PM)
After School Program (2:30 PM - 6:00 PM)
Undecided
Potty Trained
*
:
Yes
No
Child 3 First Name
*
:
Child 3 Last Name
*
:
Child 3 Date of Birth
*
:
Child 3 Desired start Date
*
:
Child 3 Preferred Program
*
:
Select Program
Full Day M-F (8:00 AM - 6:00 PM)
Full Day MWF (8:00 AM - 6:00 PM)
Full Day TTH (8:00 AM - 6:00 PM)
Half Day M-F (8:30 AM - 11:30 AM)
Half Day MWF (8:30 AM - 11:30 AM)
Half Day TTH (8:30 AM - 11:30 AM)
Extended Day M-F (8:30 AM - 2:30 AM)
Extended Day MWF (8:30 AM - 2:30 AM)
Extended Day TTH (8:30 AM - 2:30 AM)
After School Program (11:30 AM - 6:00 PM)
After School Program (2:30 PM - 6:00 PM)
Undecided
Potty Trained
*
:
Yes
No
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Disclaimer : Waiting list information will be sent to the appropriate site. Space in the programs is filled on a first come first serve basis.
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