Request Information

Thank you for your interest in our school!

Please fill out the form below and our office will contact you and provide the information you desire.

* Indicates a required field.

Parent/Guardian Information
*First Parent/Guardian
Salutation *

First Name *

Middle Name

Last Name *
Email Address *

Gender

Male Female
Second Parent/Guardian
Salutation

First Name

Middle Name

Last Name
Email Address

Gender

Male Female
How Did You Hear About Us?

Details:
Home Phone *

(Ex: 999-999-9999)
Street Address
City
Country
State
Zip
Please indicate information that you desire.
Student 1
First Name *

Last Name *
Birthdate *

(mm/dd/yyyy)

Gender *

Male Female
Grade Level of Interest *

School Year *
Current School

Other:
PRESCHOOL ONLY

Your child will be three-years-old or older by September 1st of the school year you wish to enroll them?

Yes No
PRESCHOOL ONLY

Your child is, or will be, fully potty-trained (No diapers, No pull-ups) by the first day of school.

Yes No
PRESCHOOL ONLY

4-5 years-old class (student must turn four years-old by September 1st.)

5 DAY: Mon through Fri 8:00am to 11:00am
PRESCHOOL ONLY

3-4 years-old morning 8:00am to 11:00am class: Which days of the week do you want to enroll your child? (minimum of three days required)

Monday Tuesday Wednesday Thursday Friday
PRESCHOOL ONLY

If you plan to use the extended After Care program between 11:00am - 5:00pm, please check which days you would like your child to attend.

Monday Tuesday Wednesday Thursday Friday Occasional Drop-In
Is There Another Student? Yes No