* = Required Information

Parent Information

Married Single Divorced Separated
Neither parent/Guardian is employed One parent or Guardian is employed Both parent/Guardians are employed

Please list all other children in your Family:

White
Black
Asian
Asian
American Indian
Other

Language spoken by your child

Government Assistance

Yes No
Yes No
Yes No

Emergency Information

In case of an Emergency, please list people who we can Contact:

Upon safety of Your Childs dismissal, Please list the people that can be trusted to pick your child up from school:

Childs History of Health

Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

Please Note: You must submit a $100 nonrefundable Registration fee.

AGE/HOURS/PRICE

Toddler (2-3 years)
8:00am-4:00pm $1,000 per month
8:00am-5:00pm $1,100 per month
8:00am-6:00pm $1,200 per month

Nursery & Pre-K (3-5 years)
8:00am-4:00pm $900 per month
8:00am-5:00pm $1,000 per month
8:00am-6:00pm $1,100 per month

Toddler (2-3 years)
8:00am-noon $550 per month

After School Program (6-12 years)
2:30pm-6:30pm $500 per month

Note: November through February Fridays we will have an early dismissal at 2pm all children must be picked up no later than 2:15pm.

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