Let's Get StartedRegistration 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 ATTENTION: Some of Our Classes Are FullThe 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 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. 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 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. Names & Ages of SiblingsNameAge Supplemental 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?* FileMax. file size: 32 MB.FileMax. file size: 32 MB.FileMax. file size: 32 MB.FileMax. file size: 32 MB.UntitledConfiguration RequiredUse the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field.NameThis field is for validation purposes and should be left unchanged.