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Child's Name:
Date of Birth:
Parents:
Address:
Address 2:
City:
State:
Zip:
Phone:
Email Address:
Program/Class applying for:
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Morning Preschool:
2 days per week
3 days per week
Child Care
Kindergarten (must be 5 by September 1st)
Modified Kindergarten (must be 5 by September 1st)
Elementary School
Before & After School Care
I need/want enrollment:
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As soon as possible
Fall/School year
Summer
On ___ (enter below)
On:
I would like to come in for a tour
Best Day:
Best Time:
Additional Comments:
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