If the class I am interested in is full: *

I am flexible and can be enrolled in another class

No, I can only make the class time I have selected.

Student Name *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

Parent or Guardian 1 Name *

First Name

Last Name

Cell Phone Number *

(###)

###

####

Work Phone Number

If applicable

(###)

###

####

Parent or Guardian 2 Name

First Name

Last Name

Cell Phone Number

(###)

###

####

Work Phone Number

If applicable

(###)

###

####

Primary Address *

Where we will send mail. Please fill in all address fields, including Country. If Address 2 does not apply to you, please enter "N/A" in that field.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact 1 Name *

First Name

Last Name

Phone Number *

(###)

###

####

Emergency Contact 2 Name *

First Name

Last Name

Phone Number *

(###)

###

####

Are you a current family enrolled in the Preschool? If you are a current family, please answer below.

My credit card information for billing is the same.

My credit card information will change. Please email me.