Complete and submit online

Enrollment Form

  • Child NameBirth DateEnrollment DateTime From (AM/PM)Time To (AM/PM) 

    (Use the plus button to add more entries)

  • Name5-Day Program (Y/N)4-Day Program (Y/N)Drop In Only (Y/N) 

    (Use the plus button to add more entries)

  • 1st Parent/Guardian

  • 2nd Parent/Guardian

  • Please provide a password that you would use when someone other than you will be picking up your child.

    This form must be completely filled out, signed, and returned. Parents’ Social Security Numbers (last 4 digits) are required for taxes and to log your child in and out every day.
  • This field is for validation purposes and should be left unchanged.

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