Please enable JavaScript in your browser to complete this form.Application for Reenrollment *I would like my child to continue for the upcoming year.My child will ONLY be enrolled through the summer months.I will withdraw my child at the end of the school year.Please select one.CHILD NAME *FirstLastCHILD NICKNAME *CHILD ADDRESS *CHILD DATE OF BIRTH *CHILD AGE *—Nursery (6wks-8mths)Creeper (8mths-12mths)Toddler 1 (12mths-18mths)Toddler 2 (18mths-24mths)Twos (2yrs)Threes (3yrs, not potty trained)Threes (3yrs, potty trained)K4 (4yrs-5yrs)CHILD GENDER *—MaleFemaleFATHER NAME *FirstLastFATHER ADDRESS *FATHER PREFERRED CONTACT TELEPHONE *FATHER HOME TELEPHONEFATHER WORK TELEPHONEFATHER eMAIL *FATHER EMPLOYER *FATHER INFORMATION *Responsible for AccountChild lives withEmergency contactAuthorized pickupSelect all that apply.MOTHER NAME *FirstLastMOTHER ADDRESS *MOTHER PREFERRED CONTACT TELEPHONE *MOTHER HOME TELEPHONEMOTHER WORK TELEPHONEMOTHER eMAIL *MOTHER EMPLOYER *MOTHER INFORMATION *Responsible for AccountChild lives withEmergency contactAuthorized pickupSelect all that apply.ALTERNATE PICKUP/EMERGENCY CONTACT 1 NAME *FirstLastALTERNATE PICKUP/EMERGENCY CONTACT 1 RELATIONSHIP *—Parent/Spouse/GuardianGrandparentRelativeFriendALTERNATE PICKUP/EMERGENCY CONTACT 1 ADDRESS *ALTERNATE PICKUP/EMERGENCY CONTACT 1 PREFERRED TELEPHONE *ALTERNATE PICKUP/EMERGENCY CONTACT 1 INFORMATIONResponsible for AccountChild lives withEmergency contactAuthorized pickupSelect all that apply.ALTERNATE PICKUP/EMERGENCY CONTACT 2 NAME *FirstLastALTERNATE PICKUP/EMERGENCY CONTACT 2 RELATIONSHIP *—Parent/Spouse/GuardianGrandparentRelativeFriendALTERNATE PICKUP/EMERGENCY CONTACT 2 ADDRESS *ALTERNATE PICKUP/EMERGENCY CONTACT 2 PREFERRED TELEPHONE *ALTERNATE PICKUP/EMERGENCY CONTACT 2 INFORMATION *Responsible for accountChild lives withEmergency contactAuthorized pickupSelect all that apply.ALTERNATE PICKUP/EMERGENCY CONTACT 3 NAME *FirstLastALTERNATE PICKUP/EMERGENCY CONTACT 3 RELATIONSHIP *—Parent/Spouse/GuardianGrandparentRelativeFriendALTERNATE PICKUP/EMERGENCY CONTACT 3 ADDRESS *ALTERNATE PICKUP/EMERGENCY CONTACT 3 PREFERRED TELEPHONE CONTACT *ALTERNATE PICKUP/EMERGENCY CONTACT 3 INFORMATION *Responsible for accountChild lives withEmergency contactAuthorized pickupSelect all that apply.PARENTAL AGREEMENT SIGNATURE *As a parent of a child registering for the upcoming year, I understand that the registration fee is non-refundable after I receive an acknowledgement from the administration accepting my child’s re-enrollment. Approved re-enrollment is based on space availability, current account status, and parent/child harmony with school program. Any concerns regarding my child’s re-enrollment will be addressed before enrollment confirmation given to parent.WebsiteSubmit