Name *

First Name

Last Name

Phone

(###)

###

####

Program Schedule

Full Day Preschool (9:00am - 5:30pm)

Extended Day Preschool (9:00am - 3:00pm)

Preschool Day (9:00am - 12:30pm)

Morning Care (7:00am - 9:00am)

Days per Week

5 Days per Week

3 Days per Week

2 Days per Week

Desired Start Date

MM

DD

YYYY