Registration – Next Year

1Child’s Information

2Enrollment Details

3Enrollment Selection

4Parent/Guardian’s

5Medical Information

6Family Facts

ATTENTION: Some of Our Classes Are Full
The following programs are currently at capacity for the 2020-2021 school year. Any students currently applying for these programs will be added to our waitlist.
- Two Year Old 3 day and 5 day Programs
- VPK, KConnect
For more information, please call us at 239.362.3929.
Enrollment Start Date*
MM slash DD slash YYYY
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 Information
Please reference this chart for pricing information.
Days Per Week*
Please choose your program
Day Duration*
Day Duration*
Day Duration*
See Pricing Chart
Do 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.

Parent/Guardian Information
Name Home Phone Cell Phone Work Phone Email Actions
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There are no Parent's/Guardian's.
Maximum number of parent's/guardian's reached.
Contacts/Emergency Contacts
Children will be released only to these authorized people listed. As well as the Parents/Guardians listed above.
Name Work phone Home Phone

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
Phone
Areas of Concern*
Please list allergies, special medical or dietary needs, or any other areas of concern.

Names & Ages of Siblings
Name Age
Supplemental Information
Please 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?*
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ATTENTION: Some of Our Classes Are Full

Name	Home Phone	Cell Phone	Work Phone	Email	Actions
					Edit Delete
There are no Parent's/Guardian's.

Name	Work phone	Home Phone

Name	Age