Enrollment Application A non-refundable application fee of $50 per child is required to submit this form. "*" indicates required fields This enrollment application is for: 1 child 2 children 3 children Child 1 InformationChild 1 is:* New Student Returning Student Sibling Military Child 1 Name* First Last Child 1 Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child 1 NicknameChild 1 Age as of 9/1*Child 1 Program ChoicesChild 1 Core Programs**Per EEC Licensing Requirements students must be 2yrs 9 mos old to attend a preschool program and is eligible for 3 years of preschool before entering kindergarten.Select OnePreschool 1 (2.9 years by 9/1/2025): 3-Day (M, T, TH) 9:00AM – 12:00PMPreschool 2 (3 – 4 year olds): 3-Day (M, T, TH) 9AM – 12:00PMPreschool 2 (3 – 4 year olds): 3-Day (M, T, TH) 9AM – 1:00PMPreschool 2 (3 – 4 year olds): 4-Day (M-TH) 9AM – 12:00PMPreschool 2 (3 – 4 year olds): 4-Day (M-TH) 9AM – 1:00PMPreschool 2 (3 – 4 year olds): 5-Day (M-F) 9AM – 12:00PMPreschool 2 (3 – 4 year olds): 5-Day (M-F) 9AM – 1:00PMPre-Kindergarten (4 – 5 year olds): 4-Day (M-TH) 9AM – 1:00PMPre-Kindergarten (4 – 5 year olds): 5-Day (M-F) 9AM – 1:00PMThis field is hidden when viewing the formSummer Program Sessions 9:00AM – 1:00PMCost per session is $330. $100 non-refundable deposit per session due within 48 hours of space confirmation Session 1: 6/23 – 6/27 Session 2: 7/7 – 7/11 Session 3: 7/14 – 7/18 Session 4: 7/21 – 7/25 Session 5: 7/28 – 8/1 Select AllEarly Birds:Drop-in/variable days, 10 kids maxSelect OneMonday – Friday 8:30AM -9:00AMLunch Bunch:Drop-in/variable daysSelect One3-Day (M, T, TH) 12:00PM – 1:00PM4-Day (M-TH) 12:00PM – 1:00PM5-Day (M-F) 12:00PM – 1:00PMExtended Day:Drop-in/variable days, 10 kids max, discount offered if paid in advanceSelect One3-Day 1:00PM – 3:00PM3-Day 1:00PM – 4:30PM4-Day 1:00PM – 3:00PM4-Day 1:00PM – 4:30PM5-Day 1:00PM – 3:00PM5-Day 1:00PM – 4:30PMIs there anything else we should as we determine your child's placement?Child 2 InformationChild 2 is:* New Student Returning Student Sibling Military Child 2 Name* First Last Child 2 Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child 2 NicknameChild 2 age as of 9/1*Child 2 Program ChoicesChild 2 Core Programs**Per EEC Licensing Requirements students must be 2yrs 9 mos old to attend a preschool program and is eligible for 3 years of preschool before entering kindergarten.Select OnePreschool 1 (2.9 years by 9/1/2025): 3-Day (M, T, TH) 9:00AM – 12:00PMPreschool 2 (3 – 4 year olds): 3-Day (M, T, TH) 9AM – 12:00PMPreschool 2 (3 – 4 year olds): 3-Day (M, T, TH) 9AM – 1:00PMPreschool 2 (3 – 4 year olds): 4-Day (M-TH) 9AM – 12:00PMPreschool 2 (3 – 4 year olds): 4-Day (M-TH) 9AM – 1:00PMPreschool 2 (3 – 4 year olds): 5-Day (M-F) 9AM – 12:00PMPreschool 2 (3 – 4 year olds): 5-Day (M-F) 9AM – 1:00PMPre-Kindergarten (4 – 5 year olds): 4-Day (M-TH) 9AM – 1:00PMPre-Kindergarten (4 – 5 year olds): 5-Day (M-F) 9AM – 1:00PMThis field is hidden when viewing the formSummer Program Sessions 9:00AM – 1:00PMCost per session is $330. $100 non-refundable deposit per session due within 48 hours of space confirmation Session 1: 6/23 – 6/27 Session 2: 7/7 – 7/11 Session 3: 7/14 – 7/18 Session 4: 7/21 – 7/25 Session 5: 7/28 – 8/1 Select AllEarly Birds:Drop-in/variable days, 10 kids maxSelect OneMonday – Friday 8:30AM -9:00AMLunch Bunch:Drop-in/variable daysSelect One3-Day (M, T, TH) 12:00PM – 1:00PM4-Day (M-TH) 12:00PM – 1:00PM5-Day (M-F) 12:00PM – 1:00PMExtended Day:Drop-in/variable days, 10 kids max, discount offered if paid in advanceSelect One3-Day 1:00PM – 3:00PM3-Day 1:00PM – 4:30PM4-Day 1:00PM – 3:00PM4-Day 1:00PM – 4:30PM5-Day 1:00PM – 3:00PM5-Day 1:00PM – 4:30PMIs there anything else we should know as we determine your child's placement?Child 3 InformationChild 3 is:* New Student Returning Student Sibling Military Child 3 Name* First Last Child 3 Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child 3 NicknameChild 3 age as of 9/1*Child 3 Program ChoicesChild 3 Core Programs**Per EEC Licensing Requirements students must be 2yrs 9 mos old to attend a preschool program and is eligible for 3 years of preschool before entering kindergarten.Select OnePreschool 1 (2.9 years by 9/1/2025): 3-Day (M, T, TH) 9:00AM – 12:00PMPreschool 2 (3 – 4 year olds): 3-Day (M, T, TH) 9AM – 12:00PMPreschool 2 (3 – 4 year olds): 3-Day (M, T, TH) 9AM – 1:00PMPreschool 2 (3 – 4 year olds): 4-Day (M-TH) 9AM – 12:00PMPreschool 2 (3 – 4 year olds): 4-Day (M-TH) 9AM – 1:00PMPreschool 2 (3 – 4 year olds): 5-Day (M-F) 9AM – 12:00PMPreschool 2 (3 – 4 year olds): 5-Day (M-F) 9AM – 1:00PMPre-Kindergarten (4 – 5 year olds): 4-Day (M-TH) 9AM – 1:00PMPre-Kindergarten (4 – 5 year olds): 5-Day (M-F) 9AM – 1:00PMThis field is hidden when viewing the formSummer Program Sessions 9:00AM – 1:00PMCost per session is $330. $100 non-refundable deposit per session due within 48 hours of space confirmation Session 1: 6/23 – 6/27 Session 2: 7/7 – 7/11 Session 3: 7/14 – 7/18 Session 4: 7/21 – 7/25 Session 5: 7/28 – 8/1 Select AllEarly Birds:Drop-in/variable days, 10 kids maxSelect OneMonday – Friday 8:30AM -9:00AMLunch Bunch:Drop-in/variable daysSelect One3-Day (M, T, TH) 12:00PM – 1:00PM4-Day (M-TH) 12:00PM – 1:00PM5-Day (M-F) 12:00PM – 1:00PMExtended Day:Drop-in/variable days, 10 kids max, discount offered if paid in advanceSelect One3-Day 1:00PM – 3:00PM3-Day 1:00PM – 4:30PM4-Day 1:00PM – 3:00PM4-Day 1:00PM – 4:30PM5-Day 1:00PM – 3:00PM5-Day 1:00PM – 4:30PMIs there anything else we should know as we determine your child's placement?Parent InformationParent 1 Name* First Last Parent 1 Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent 1 Cell Phone*Parent 1 Email* Username*Password* Strength indicator Parent 2 Name First Last Parent 2 Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent 2 Cell PhoneParent 2 Email Signature of Parent or Guardian*Date of Application*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Credit Card*Card Details Cardholder Name
