Let's Get StartedRegistration "*" indicates required fields 1Child’s Information2Enrollment Details3Enrollment Selection4Parent/Guardian’s5Medical Information6Family Facts Name* First Last Preferred Name For our use.Date of Birth* MM slash DD slash YYYY Gender* Male Female Address* Street Address Address Line 2 City ZIP Code Age on September 1st of the current year*This is used to determine enrollment options, please be accurate with your input.Please enter a number from 1 to 5. Pricing InformationPlease reference this chart for pricing information.Days Per Week*2 Day (Mon/Tues)3 Day (Wed/Thurs/Friday)5 Day (Mon-Friday)Please choose your programDay Duration*Preschool Day (8:30-12:30)School Day (8:30-2:30)Full Day (7:30-5:30)Day Duration*VPK Morning (8:30-11:30) – (up to 540hrs) included with voucherPreschool Day (8:30-12:30)School Day (8:30-2:30)Full Day (7:30-5:30)Day Duration*Choose OneSchool Day (8:30-2:30)Full Day (7:30-5:30)See Pricing ChartDo You Need Extra Care Hours?* Yes No We offer flexible drop off and pickup times within the full day range (7:30-5:30) for an hourly rate. Please contact the office at 239.362.3929 for details.Pickup Time*Preschool day 8:30-12:30School day 8:30-2:30Full day 7:30-5:30Voucher only (VPK) 8:30-11:30 Parent/Guardian Information Name Home Phone Cell Phone Work Phone Email Actions Edit Delete There are no Parent's/Guardian's. Add Parent/Guardian Maximum number of parent's/guardian's reached. Contacts/Emergency ContactsChildren will be released only to these authorized people listed. As well as the Parents/Guardians listed above.NameWork phoneHome Phone Add Remove I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted. Doctor Location PhoneAreas of Concern*Please list allergies, special medical or dietary needs, or any other areas of concern.Parent Signature* Names & Ages of SiblingsNameAge Add RemoveSupplemental InformationPlease list any other information that might help us to better understand your child (i.e. fears, recent death or divorce in the family, a new baby, adoption, and what the child has been told about these events.At what church do you worship or serve?* Previous preschool/small group experiences?* NameThis field is for validation purposes and should be left unchanged.
