Class Enrollment Form

Child’s Information

Child’s Last Name (required)

Child’s First Name (required)

Child’s Date of Birth (required)

Home Contact Information

Address

City

State

Zip

Home Phone

Mother’s Contact Information

First and Last Name

Occupation

Cell Phone Number

Business Phone Number

Father’s Contact Information

First and Last Name

Occupation

Cell Phone Number

Business Phone Number

General Information Information

Hold control key and select all that apply.

Gender

How did you hear about us?

Class Information

TTH Classes-8:45am-11:45am (2 days)

MWF Classes-8:45am-11:45am (3 days)

M-TTH Classes-8:45am-12:00pm (4 days)

Must be age appropriate by Sept. 30th, 2014 and fully toilet trained. Twos do not have to be toilet trained.