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Tuition
Contact Us
Child's Name
*
First Name
Last Name
Age
*
Birthdate
*
MM
DD
YYYY
Gender
Male
Female
Address
*
Legal Guardian 1
*
First Name
Last Name
Cell Phone
*
(###)
###
####
Occupation
*
Legal Guardian 2
*
First Name
Last Name
Cell Phone
(###)
###
####
Occupation
Email
*
Age Group
*
0-1 yr old
1-2 yrs old
2 yrs old
3-5 yrs old
Schedule Needed?
*
Full Time
Part Time
Days Needed?
*
Mon
Tues
Wed
Thurs
Fri
Hours Needed?
*
Potty Trained?
*
Yes
No
Special Needs?
Private Pay or Program?
Option 1
Option 2
If program, which one?
Has your child been in a group setting before?
How did you hear about us?
Friends/co-worker
Online
Other
Thank you!
