Let's Get StartedRegistration1 Child’s Information2 Enrollment Details3 Enrollment Selection4 Parent/Guardian’s5 Medical Information6 Family FactsName* First Last Preferred NameFor our use.Date of Birth* Date Format: MM slash DD slash YYYY Gender*MaleFemaleAddress* 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 ProgramsVPK, KConnect For more information, please call us at 239.362.3929.Enrollment Start Date* Date Format: MM slash DD slash YYYY Age on Enrollment Date*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.Day Duration*Choose OnePreschool Day (8:30-12:30)School Day (8:30-2:30)Full Day (7:30-5:30)Day Duration*Choose OneVPK Morning (8:30-11:30) – (up to 540hrs) included with voucherPreschool Day (8:30-12:30) – $240 per monthSchool Day (8:30-2:30) - $445 per monthFull Day (7:30-5:30) - $855 per monthDay Duration*Choose OneSchool Day (8:30-2:30)Full Day (7:30-5:30)Days Per Week*Select a Program2 Day (Mon/Tues)3 Day (Wed/Thurs/Friday)5 Day (Mon-Friday)Do You Need Extra Care Hours?*YesNoWe 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 EmailActions EditDelete 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. DoctorLocationPhoneAreas 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?*FileFileFileFileUntitledConfiguration RequiredUse the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field.EmailThis field is for validation purposes and should be left unchanged.