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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