Father's Full Name *
Father's Full Name
Mother's Full Name *
Mother's Full Name
Address *
Address
Phone Number *
Phone Number
Child's Name *
Child's Name
Child's Birthday *
Child's Birthday
Program *
Days of the Week Interested In: *
All classes are in session from 8:30AM - 12:30PM
Are you interested in our Extended Care?**

**Childcare is available daily from 7:30AM until 5:30PM on a regular schedule or as needed. These hours are billed separately at the rate of $10 per hour. Please connect with our office to make arrangements. 

Please note, this is only an inquiry form, NOT an application.